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# Sodium Phosphate Enema
## Overview
Sodium phosphate enema is a hypertonic saline solution that acts as a stimulant laxative and osmotic agent to promote bowel evacuation.
## Primary Indications
* Bowel preparation for diagnostic procedures (e.g., colonoscopy, sigmoidoscopy).
* Relief of occasional constipation.
## Adult Dosing
* **Bowel Preparation:** Typically a single dose of 45 mL (delivering 13.5 g sodium phosphate and 3 g inorganic phosphate) administered rectally as an enema. May be repeated once if needed, but generally not within 24 hours.
* **Constipation:** 2.25 g to 4.5 g sodium phosphate (equivalent to 1/2 to 1 standard Fleet Enema bottle of 4.5 fl oz or 133 mL total volume containing 2.25 g/1.5 fl oz) administered rectally as an enema.
## Pediatric Dosing
* **Children 2 to under 12 years:** 1/2 the adult dose (approximately 2.25 g sodium phosphate).
* **Children under 2 years:** Use with extreme caution and only under medical supervision. Dosing is not well established and depends on clinical judgment.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Monitor electrolytes closely due to risk of hyperphosphatemia and hypocalcemia.
* **Heart Failure/Renal Impairment:** Caution is advised due to the potential for fluid and electrolyte shifts.
## Contraindications
* Congestive heart failure.
* Hyperphosphatemia.
* Hypocalcemia.
* Renal insufficiency.
* Children under 2 years of age (relative contraindication due to increased risk of toxicity).
* Intestinal obstruction.
* Congenital megacolon.
* Patients with impaired ability to retain the enema.
## Adverse Effects
* **Common:** Abdominal cramping, bloating, nausea, vomiting, diarrhea.
* **Serious:**
* **Electrolyte imbalances:** Hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, dehydration. This can lead to cardiac arrhythmias, tetany, seizures, and renal failure.
* **Rectal irritation, pain, or burning.**
* **Rarely:** Ulceration or perforation of the rectal mucosa.
## Key Drug Interactions
* **Calcium-containing medications:** May increase the risk of hyperphosphatemia.
* **Diuretics:** May exacerbate electrolyte disturbances.
* **Medications that prolong QT interval:** Dehydration and electrolyte imbalances can increase the risk of arrhythmias.
## Monitoring
* **Renal function (serum creatinine, BUN).**
* **Electrolytes (serum phosphate, calcium, sodium, potassium).**
* **Fluid status and signs of dehydration.**
* **Signs of hypocalcemia (e.g., paresthesias, muscle cramps, tetany).**
* **Signs of hyperphosphatemia (e.g., flank pain, decreased urine output).**
## Clinical Pearls
* Administer slowly and ensure patient retains the enema for the prescribed duration (typically 5-15 minutes) to maximize effectiveness and minimize systemic absorption.
* Encourage fluid intake to prevent dehydration.
* Not recommended for routine or chronic use due to the risk of electrolyte imbalances and laxative dependence.
* The risk of serious adverse effects, particularly electrolyte disturbances and renal injury, is significantly higher in children and patients with renal impairment.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment or current prescribing information. Always consult the official drug monograph and institutional protocols for complete and up-to-date guidance before prescribing or administering any medication.
