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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 bowel, stimulating peristalsis and producing a bowel movement. It is a potent osmotic laxative.
## Primary Indications
* Bowel preparation for diagnostic procedures (e.g., colonoscopy, sigmoidoscopy)
* Short-term treatment of occasional constipation
## Adult Dosing
* **Bowel preparation:** Typically, one 4.5 oz (133 mL) enema administered 3-5 hours before the procedure. May require a second dose 2-4 hours prior if recommended by the physician or local protocol.
* **Constipation:** One 4.5 oz (133 mL) enema as a single dose. Do not administer more than one dose in 24 hours.
## Pediatric Dosing
* **Ages 2-11 years:** One-half the adult dose (approximately 2.25 oz or 66.5 mL) as a single dose.
* **Children under 2 years:** Not recommended without specific physician guidance due to increased risk of electrolyte imbalance.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
* Congestive heart failure
* Gastrointestinal obstruction
* Acute liver failure
* Perforated bowel
* Severe renal impairment (CrCl < 30 mL/min)
* Congenital megacolon
* Known hypersensitivity to sodium phosphate
* Patients with ileostomy or colostomy
* Children under 2 years of age (unless specifically directed by a physician)
* Use in patients with inadequate fluid intake or those on diuretics that may cause dehydration.
## Adverse Effects
* **Common:** Abdominal cramping, bloating, nausea, vomiting, rectal irritation.
* **Serious:**
* **Electrolyte abnormalities:** Hyperphosphatemia, hypocalcemia, hypernatremia, metabolic acidosis. Risk is increased with repeated use, in patients with renal impairment, or in children.
* **Dehydration:** Due to osmotic fluid shifts.
* **Rare:** Cardiac arrhythmias, seizures, renal failure.
## Key Drug Interactions
* **Diuretics:** Increased risk of electrolyte imbalance and dehydration.
* **ACE inhibitors/ARBs:** Increased risk of hyperkalemia.
* **Lithium:** Can decrease lithium levels due to increased elimination.
## Monitoring
* Monitor for signs and symptoms of dehydration (thirst, dry mouth, decreased urine output).
* Monitor for signs and symptoms of electrolyte imbalance (nausea, vomiting, muscle weakness, confusion, irregular heartbeat).
* Electrolyte levels (sodium, phosphate, calcium, potassium) may be considered in patients at high risk, especially with repeated use or underlying renal dysfunction.
## Clinical Pearls
* This product should not be used for chronic constipation due to the risk of severe electrolyte disturbances.
* Ensure adequate fluid intake before and after administration.
* Do not administer if bowel movement has occurred within the last 24 hours.
* Educate patients on proper administration technique and potential side effects.
* Use with extreme caution in elderly patients or those with pre-existing renal or cardiac conditions.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete details, including potential contraindications, warnings, precautions, and interactions. Ensure patient-specific factors are considered before making prescribing decisions.
