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## Sodium Phosphate Enema (e.g., Fleet Enema)
### Overview
Sodium phosphate enema is a hypertonic saline solution used as a saline laxative and to cleanse the bowel.
### Primary Indications
* Bowel preparation prior to colonoscopy or surgery.
* Relief of occasional constipation.
### Adult Dosing
* **Bowel Preparation:** Typically, one 4.5 oz (133 mL) enema is administered as directed by the healthcare provider, usually the evening before or morning of the procedure. Do not administer more than one dose in 24 hours.
* **Constipation:** One 4.5 oz (133 mL) enema administered as a single dose.
### Pediatric Dosing
* **Ages 2 to < 12 years:** Use with caution. The recommended dose is typically half the adult dose (approximately 2.25 oz or 67 mL), administered as a single dose. Specific dosing should be guided by a healthcare provider.
* **Under 2 years:** Generally not recommended due to increased risk of electrolyte imbalance. Consult a healthcare provider for any use.
### Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment, but caution is advised due to potential for electrolyte disturbances.
### Contraindications
* Congenital or acquired megacolon.
* Heart failure.
* Renal impairment.
* Ascites.
* Ileus or bowel obstruction.
* Children under 2 years of age.
* Patients with conditions that increase the risk of electrolyte imbalance or fluid overload (e.g., existing hyperphosphatemia, hypocalcemia, hypernatremia).
* Hypersensitivity to sodium phosphate.
### Adverse Effects
* **Common:** Abdominal cramping, bloating, nausea, vomiting, diarrhea.
* **Serious:** Rectal irritation or bleeding, electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypernatremia, hyponatremia), dehydration, acute kidney injury, cardiac arrhythmias, seizures, particularly in children or those with underlying risk factors.
### Key Drug Interactions
* **Diuretics:** Increased risk of electrolyte imbalance.
* **ACE inhibitors/ARBs:** Increased risk of hyperkalemia and acute kidney injury.
* **Calcium channel blockers:** Potential for hyperkalemia.
* **Laxatives:** Concomitant use may potentiate dehydration and electrolyte disturbances.
### Monitoring
* Monitor for signs and symptoms of electrolyte imbalance (e.g., muscle cramps, weakness, confusion, irregular heartbeat).
* Assess for adequate hydration.
* Monitor renal function (BUN, creatinine) especially in at-risk patients or with repeated use.
### Clinical Pearls
* Do not administer orally; this product is for rectal use only.
* Warn patients to stop use and contact a healthcare provider if they experience severe abdominal pain, rectal bleeding, or lack of bowel movement after using the enema.
* Ensure adequate fluid intake before and after administration to prevent dehydration.
* Avoid use in patients with impaired renal function or those on medications that can affect renal function or electrolytes.
* Use with extreme caution in pediatric patients.
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*Disclaimer: This information is intended for clinical pharmacy use and does not replace the need to consult the most current prescribing information, institutional protocols, or a healthcare provider.*
