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# Ezivac Enema (Sodium Phosphate)
## Overview
Ezivac contains Sodium Phosphate Monobasic and Sodium Phosphate Dibasic. It functions as a saline osmotic laxative by drawing water into the colonic lumen, inducing distension and prompt evacuation.
## Primary Indications
* Relief of occasional constipation.
* Bowel preparation for diagnostic procedures (e.g., colonoscopy) or surgery.
## Adult Dosing
* **For Constipation:** Administer one 118 mL (delivered dose) unit rectally as a single dose. Do not exceed one dose in 24 hours.
* **For Bowel Preparation:** Follow specific institutional protocols, which may require 1–2 units administered 1–2 hours apart.
## Pediatric Dosing
* **Children 12 years and older:** Same as adult dose.
* **Children 2 to 11 years:** 59 mL (pediatric size) rectal dose.
* **Children under 2 years:** Contraindicated.
* *Note:* Use extreme caution as pediatric patients are highly susceptible to severe electrolyte disturbances (hyperphosphatemia, hypocalcemia, hypernatremia).
## Dose Adjustments
* **Renal Impairment:** Avoid use in patients with significant renal impairment due to the risk of hyperphosphatemia and subsequent metastatic calcification.
* **Geriatric:** Use with caution; monitor for dehydration and electrolyte shifts.
## Contraindications
* Hypersensitivity to sodium phosphates.
* Congestive heart failure.
* Ascites.
* Known or suspected bowel obstruction, perforation, or active inflammatory bowel disease (megacolon).
* Renal failure.
## Adverse Effects
* **Severe:** Severe electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypokalemia, hypernatremia), dehydration, acute phosphate nephropathy, and cardiac arrhythmias (secondary to electrolyte shifts).
* **Common:** Abdominal pain, cramping, nausea, vomiting, dizziness, and rectal irritation.
## Key Drug Interactions
* **Diuretics (Loop/Thiazide):** May increase risk for electrolyte abnormalities and dehydration.
* **ACE Inhibitors/ARBs/NSAIDs:** May increase the risk of acute kidney injury when combined with phosphate-based laxatives.
* **Calcitonin/Bisphosphonates:** Risk of additive hypocalcemia.
## Monitoring
* Baseline and post-dose serum electrolytes (Phosphorus, Calcium, Sodium, Potassium).
* Renal function (BUN/SCr).
* Hydration status and stool frequency/consistency.
## Clinical Pearls
* **Positioning:** Patient should lie on the left side with knees bent (Sims' position) during administration.
* **Safety:** Do not force the enema tip into the rectum to avoid mucosal trauma or perforation.
* **Hydration:** Ensure adequate oral fluid intake before and after administration to mitigate dehydration risk.
* **Uncertainty:** Pediatric dosing and specific "bowel prep" regimens vary significantly by clinical setting; always verify against local hospital formulary or institutional procedural guidelines.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical parameters and dosing protocols may change. Always consult current institutional guidelines, electronic prescribing databases (e.g., Lexicomp, Micromedex), and the patient's individual medical record before prescribing or administering medication.
