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# Sodium Phosphate Enema
## Overview
Sodium phosphate enema is a hypertonic saline solution used for bowel cleansing. It works by drawing water into the colon through osmosis, which softens stool and stimulates bowel evacuation.
## Primary Indications
* Bowel preparation for diagnostic procedures (e.g., colonoscopy, barium enema).
* Relief of occasional constipation.
## Adult Dosing
* **Bowel Preparation:** Typically, one 4.5 oz (133 mL) enema administered 3-5 hours before the procedure. For some procedures, a second enema may be ordered.
* **Constipation:** One 2.25 oz (66 mL) enema. Do not exceed one dose in 24 hours.
## Pediatric Dosing
* **Ages 2-11 years:** One 2.25 oz (66 mL) enema.
* **Under 2 years:** Contraindicated due to risk of hypernatremia and dehydration. Use with extreme caution and only under strict medical supervision if alternative agents are not feasible. Dosing is not well-established; consult specific pediatric guidelines or a pediatric specialist.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised due to the electrolyte load.
## Contraindications
* Congenital or acquired megacolon.
* Heart failure.
* Gastrointestinal obstruction or perforation.
* Ileus.
* Severe renal impairment (CrCl <30 mL/min).
* Children under 2 years of age.
* Patients with impaired gag reflex or risk of aspiration.
* Patients with known or suspected hypersensitivity to sodium phosphate.
## Adverse Effects
* Nausea, vomiting, abdominal cramping, bloating.
* Electrolyte disturbances (hypernatremia, hypocalcemia, hyperphosphatemia, hypokalemia), which can be severe and life-threatening, especially in the elderly, very young, or those with renal impairment.
* Dehydration.
* Cardiac arrhythmias.
* Renal injury.
## Key Drug Interactions
* **Diuretics, ACE inhibitors, ARBs, NSAIDs:** Increased risk of hypernatremia and renal injury.
* **Drugs affecting fluid and electrolyte balance:** Monitor closely.
## Monitoring
* Monitor for signs of dehydration (thirst, dry mouth, decreased urine output, dizziness).
* Monitor for signs of electrolyte imbalance (muscle cramps, weakness, confusion, palpitations).
* Renal function (serum creatinine) may be considered in high-risk patients.
## Clinical Pearls
* Administer slowly and keep fluid within the rectum for the recommended time (usually 5-10 minutes).
* Patient should be in a comfortable position, preferably left lateral decubitus.
* Encourage fluid intake to prevent dehydration.
* Avoid use in patients with any risk factors for electrolyte imbalance or fluid overload.
* Consider alternative bowel preparation agents for patients with renal impairment, heart failure, or other contraindications.
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*Please verify current prescribing information and local protocols for definitive guidance.*
