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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 induce evacuation of the bowel.
## Primary Indications
* Bowel preparation prior to colonoscopy or surgical procedures.
* Relief of occasional constipation.
## Adult Dosing
* **Bowel Preparation:** Typically, a single 4.5 fl oz (133 mL) enema administered once, 12-24 hours before the procedure.
* **Constipation:** Single 2.25 fl oz (66 mL) enema administered once. Do not use more than one dose in 24 hours.
## Pediatric Dosing
* **Ages 5-11 years:** Single 2.25 fl oz (66 mL) enema administered once.
* **Under 5 years:** Contraindicated.
## Dose Adjustments
No specific dose adjustments for renal or hepatic impairment are routinely provided for enema use. However, caution is advised in patients with renal impairment due to risk of hyperphosphatemia.
## Contraindications
* Congenital megacolon.
* Heart failure.
* Ileus.
* Intestinal obstruction or perforation.
* Acute bowel inflammation (e.g., Crohn's disease, ulcerative colitis).
* Congenital megacolon.
* Renal impairment (contraindicated in pediatric patients < 5 years).
* Patients on medications that may affect electrolytes or hydration status (e.g., diuretics).
## Adverse Effects
* **Common:** Abdominal cramping, bloating, nausea, vomiting, rectal irritation.
* **Serious:**
* **Electrolyte disturbances:** Hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia. This is a significant risk, particularly with overuse or in susceptible patients (e.g., renal impairment, elderly). Symptoms can include tetany, seizures, cardiac arrhythmias, and dehydration.
* **Renal injury:** Acute kidney injury.
* **Rectal ulceration or perforation.**
## Key Drug Interactions
* **Diuretics, ACE inhibitors, ARBs, NSAIDs:** Increased risk of hyperphosphatemia and renal injury.
* **Calcium-containing medications:** May increase risk of hypercalcemia and hyperphosphatemia.
* **Drugs affecting gastrointestinal motility:** May alter absorption and efficacy.
## Monitoring
* Monitor for signs and symptoms of electrolyte imbalance (e.g., muscle cramps, weakness, confusion, dizziness, nausea).
* Assess hydration status.
* Monitor renal function (serum creatinine) in patients with risk factors (e.g., renal impairment, elderly, frequent use).
## Clinical Pearls
* Due to the risk of serious electrolyte disturbances and renal injury, sodium phosphate enemas should be used with caution and only as directed.
* Avoid frequent or prolonged use.
* Ensure adequate hydration before and after administration.
* Educate patients on proper administration technique and potential adverse effects.
* In pediatric patients, ensure correct age-appropriate dosing.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*
