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# Ezivac Enema (Sodium Phosphate)
## Overview
Ezivac is a hypertonic saline osmotic laxative administered rectally. It works by drawing water into the colon, increasing internal pressure to stimulate peristalsis and evacuation.
## Primary Indications
Relief of occasional constipation and bowel preparation prior to diagnostic procedures (e.g., sigmoidoscopy).
## Adult Dosing
* **Standard dose:** One 118 mL unit (delivered volume) rectally as a single dose.
* **Maximum:** Do not exceed one dose in a 24-hour period.
## Pediatric Dosing
* **Children 2 to 11 years:** 59 mL rectally as a single dose.
* **Children under 2 years:** Not recommended.
* *Note:* Always verify local institutional protocols, as some facilities restrict pediatric use due to the risk of severe electrolyte shifts.
## Dose Adjustments
No formal renal or hepatic dose adjustments, but extreme caution is required in patients with pre-existing renal impairment, electrolyte imbalances, or congestive heart failure due to the risk of systemic absorption of phosphate.
## Contraindications
* Hypersensitivity to sodium phosphate.
* Megacolon (congenital or acquired).
* Known or suspected bowel obstruction, perforation, or active inflammatory bowel disease (IBD).
* Presence of anal fissures or rectal bleeding.
* Congestive heart failure or clinically significant renal impairment (caution, not absolute, but typically contraindicated for bowel prep).
## Adverse Effects
* **Common:** Abdominal cramping, nausea, rectal irritation.
* **Severe (Rare but critical):** Severe hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, dehydration, and metabolic acidosis. Cardiac arrhythmia secondary to electrolyte disturbance.
## Key Drug Interactions
* **Diuretics:** Increased risk of electrolyte imbalance (dehydration, hypotension).
* **Calcium Channel Blockers:** Potential for increased risk of hypocalcemia.
* **Drugs that prolong QT interval:** Risk of additive cardiac complications if electrolyte disturbances (hypokalemia/hypocalcemia) occur.
* **Other laxatives:** Avoid concurrent use of other oral or rectal laxatives to prevent severe osmotic fluid shifts.
## Monitoring
* Monitor for signs of dehydration (thirst, decreased urine output).
* In vulnerable populations: Serum electrolytes (sodium, phosphate, calcium, potassium) and creatinine levels if multiple doses are administered or if symptoms of toxicity (e.g., tetany, arrhythmias) occur.
## Clinical Pearls
* **Technique:** Position the patient on the left side with knees bent. Gently insert the lubricated nozzle into the rectum directed toward the navel. Do not force insertion.
* **Absorption:** While intended for local action, phosphate is absorbed systemically. The risk of toxicity is highest in patients with renal failure.
* **Onset:** Usually produces a bowel movement within 2 to 15 minutes.
* **Education:** Ensure patients are aware that failure to produce a bowel movement within 30 minutes may indicate a fecal impaction; discontinue use and contact a physician.
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**Educational Disclaimer:** This information is for educational purposes only and is not a substitute for professional medical judgment. Always verify current prescribing information through official package inserts, institutional pharmacy protocols, or clinical decision support tools before prescribing or administering.
