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# Sodium Phosphate Enema
## Overview
Sodium phosphate enema is a hypertonic saline solution that acts as a stimulant laxative by drawing water into the colon, increasing peristalsis, and softening stool.
## Primary Indications
Bowel preparation prior to colonoscopy or surgery; treatment of occasional constipation.
## Adult Dosing
**Bowel Preparation:** Typically, a single 4.4 oz (133 mL) bottle is administered 12-18 hours before the procedure. Some protocols may recommend a second dose.
**Constipation:** 1.125 oz (33 mL) to 4.4 oz (133 mL) administered once.
## Pediatric Dosing
**Constipation (ages 2-11 years):** 1.125 oz (33 mL) administered once. Not recommended for children under 2 years of age without medical supervision.
## Dose Adjustments
No specific dose adjustments for renal or hepatic impairment are typically required for occasional enema use due to limited systemic absorption. However, caution is advised in patients with compromised renal function.
## Contraindications
* Congenital or acquired megacolon
* Intestinal obstruction or perforation
* Severe renal impairment (CrCl < 30 mL/min)
* Heart failure
* Electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypernatremia)
* Patients on medications that affect electrolyte balance (e.g., diuretics, ACE inhibitors, ARBs)
* Children less than 2 years of age
* Known hypersensitivity to sodium phosphate
## Adverse Effects
Common: Abdominal cramping, bloating, nausea, vomiting, rectal irritation.
Serious: **Serious risk of electrolyte disturbances**, including hyperphosphatemia, hypocalcemia, hypernatremia, and metabolic acidosis, which can lead to seizures, cardiac arrhythmias, hypotension, and renal failure. Dehydration.
## Key Drug Interactions
* **Diuretics, ACE inhibitors, ARBs, NSAIDs:** Increased risk of hypernatremia, hyperphosphatemia, and hypocalcemia.
* **Calcium supplements:** Increased risk of hyperphosphatemia.
* **Drugs affecting gut motility:** May alter absorption or efficacy.
## Monitoring
Monitor for signs and symptoms of electrolyte imbalance (e.g., thirst, decreased urination, muscle weakness or cramps, confusion, dizziness, irregular heartbeat). Serum electrolytes may be monitored, especially in patients with risk factors for imbalance.
## Clinical Pearls
* Administer chilled to improve palatability and reduce cramping.
* Encourage adequate oral fluid intake before and after administration to minimize dehydration and electrolyte disturbances.
* Use with extreme caution in elderly patients, those with renal impairment, or those with pre-existing electrolyte abnormalities.
* Avoid repeated use; it is intended for occasional constipation.
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*This information is intended for healthcare professionals. Please consult the official prescribing information and current clinical guidelines for complete details and to verify information before making any treatment decisions.*
