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# Sodium Phosphate Enema (e.g., Fleet Enema)
## Overview
Sodium phosphate enema is a hypertonic saline solution that draws water into the colon, promoting bowel evacuation.
## Primary Indications
Bowel preparation for diagnostic procedures (e.g., colonoscopy, barium enema) and surgical procedures. Treatment of occasional constipation.
## Adult Dosing
* **Bowel Preparation:** Typically, one 4.5 oz (133 mL) enema is administered as a single dose. In some protocols, a second dose may be given several hours later, but this should be guided by local protocol.
* **Constipation:** One 4.5 oz (133 mL) enema administered as a single dose. Not intended for chronic use.
## Pediatric Dosing
* **Ages 2 to under 12 years:** One-half the adult dose (approximately 2.25 oz or 67 mL).
* **Under 2 years:** Generally not recommended due to increased risk of toxicity. Use with extreme caution and under strict medical supervision if absolutely necessary. Dosing is not established and depends on clinical context.
## Dose Adjustments
No specific dose adjustments are routinely recommended based on renal or hepatic impairment, but caution is advised due to the risk of electrolyte imbalances.
## Contraindications
* Congenital or acquired megacolon.
* Intestinal obstruction or perforation.
* Severe renal impairment (CrCl < 30 mL/min).
* Heart failure, congestive heart failure, or conditions that may be exacerbated by fluid or electrolyte shifts.
* Anuria or known hypocalcemia.
* Use with other sodium phosphate products.
* Patients on medications that prolong the QT interval.
* Children under 2 years of age.
## Adverse Effects
* **Common:** Abdominal discomfort, cramping, bloating, nausea, vomiting, diarrhea.
* **Serious:**
* **Electrolyte Imbalances:** Hypernatremia, hyperphosphatemia, hypocalcemia, hypokalemia. Symptoms may include muscle cramps, weakness, confusion, irregular heartbeat, seizures.
* **Renal Toxicity:** Acute kidney injury, especially in patients with pre-existing renal disease or those who are dehydrated.
* **Cardiac Arrhythmias:** Due to electrolyte disturbances.
* **Rectal irritation or bleeding.**
## Key Drug Interactions
* **Diuretics (thiazide, loop):** Increased risk of hypernatremia and hyperphosphatemia.
* **ACE inhibitors and ARBs:** Increased risk of hyperkalemia.
* **Calcium channel blockers and other drugs prolonging QT interval:** Increased risk of cardiac arrhythmias.
* **Other Sodium Phosphate products:** Additive risk of electrolyte abnormalities.
## Monitoring
* Electrolytes (sodium, potassium, phosphate, calcium) and renal function (BUN, creatinine) are particularly important in patients with risk factors for imbalance (e.g., renal impairment, elderly, concomitant diuretic use).
* Assess for signs and symptoms of dehydration and electrolyte disturbances.
## Clinical Pearls
* Administer slowly and as directed. Retention of the enema is necessary for effectiveness.
* Ensure adequate hydration before and after administration.
* Contraindicated in patients with impaired rectal passage or severe abdominal pain, nausea, vomiting, or signs of intestinal obstruction.
* Use with caution in the elderly and in patients with impaired renal function.
* Avoid in patients with ileostomy or colostomy due to risk of electrolyte absorption.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details and to verify this information before making clinical decisions.*
