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# Sodium Phosphate Enema
## Overview
Sodium phosphate enema is a hypertonic saline solution that acts as a saline laxative, drawing water into the colon to stimulate bowel evacuation.
## Primary Indications
* Bowel preparation for colonoscopy or surgery.
* Relief of occasional constipation.
## Adult Dosing
* **Bowel Preparation:** Typically, one 4.5 oz (133 mL) bottle administered orally or rectally, 2-5 hours prior to the procedure. May require a second dose if bowel is not clear, per institutional protocol.
* **Constipation:** One 4.5 oz (133 mL) bottle administered rectally.
## Pediatric Dosing
* **Ages 2-5 years:** 1/2 to 1 adult dose (2.25-4.5 oz or 66-133 mL) administered rectally. **Caution is advised due to risk of electrolyte imbalance.**
* **Ages 6-12 years:** 1 adult dose (4.5 oz or 133 mL) administered rectally.
* **Children younger than 2 years:** Contraindicated.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment. However, caution is advised, especially in patients with known renal dysfunction, due to potential for electrolyte disturbances.
## Contraindications
* Congenital or acquired megacolon.
* Bowel obstruction or perforation.
* Severe renal impairment (CrCl < 30 mL/min).
* Congestive heart failure.
* Anuria.
* Patients on certain medications (e.g., diuretics, ACE inhibitors) that may increase the risk of hyperphosphatemia, hypocalcemia, or hypernatremic dehydration.
* Children younger than 2 years of age.
* Hypersensitivity to sodium phosphate.
## Adverse Effects
* Nausea, vomiting, abdominal cramping, bloating.
* Electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia), which can lead to dehydration, renal failure, seizures, cardiac arrhythmias, and death.
* Rectal irritation or pain.
* Rarely, allergic reactions.
## Key Drug Interactions
* **Diuretics (e.g., furosemide, hydrochlorothiazide):** Increased risk of dehydration and electrolyte imbalances.
* **ACE inhibitors/ARBs (e.g., lisinopril, losartan):** Increased risk of hyperkalemia and renal impairment.
* **Other laxatives:** May potentiate dehydration and electrolyte loss.
* **Medications affected by bowel motility or transit time:** Absorption may be altered.
## Monitoring
* Electrolytes (phosphate, calcium, sodium, potassium) should be monitored, especially in patients with risk factors for imbalance (e.g., renal impairment, elderly, children, those on concomitant medications).
* Renal function.
* Hydration status.
## Clinical Pearls
* This product is a hypertonic solution and should be used with extreme caution in children and the elderly due to the risk of severe electrolyte disturbances and dehydration.
* Ensure adequate hydration before and after administration.
* Do not use for prolonged periods or for chronic constipation.
* Rectal administration is generally preferred for bowel preparation to minimize systemic absorption risks.
**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines or drug compendia before making clinical decisions.
