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# Ezivac Enema
## Overview
Ezivac (Sodium Phosphate) is a hypertonic saline osmotic laxative used for bowel evacuation. It works by drawing water into the colon, increasing internal pressure to stimulate peristalsis and defecation.
## Primary Indications
* Relief of occasional constipation.
* Bowel preparation for diagnostic examinations (e.g., colonoscopy, sigmoidoscopy) or surgical procedures.
## Adult Dosing
* **Constipation:** 118 mL (one ready-to-use unit) rectally as a single dose.
* **Bowel Prep:** Follow facility-specific protocols. Typically 1–2 doses administered as directed by the clinician.
* **Maximum:** Do not exceed one dose in 24 hours.
## Pediatric Dosing
* **Children 12 years and older:** Same as adult dose.
* **Children 2 to 11 years:** Use pediatric-specific formulations (usually 59 mL).
* **Children under 2 years:** Contraindicated.
* *Note: Dosing should always be confirmed via local pediatric clinical protocols.*
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. High risk of hyperphosphatemia, hypocalcemia, and hypernatremia due to poor phosphate excretion.
* **Geriatric/Debilitated:** Use with caution; monitor for electrolyte imbalances and dehydration risk.
## Contraindications
* Hypersensitivity to sodium phosphates.
* Megacolon (congenital or acquired).
* Known or suspected bowel obstruction or perforation.
* Active inflammatory bowel disease (e.g., ulcerative colitis).
* Congestive heart failure or severe renal impairment.
## Adverse Effects
* **Common:** Rectal irritation, abdominal cramping, nausea.
* **Serious:** Dehydration, hyperphosphatemia, hypocalcemia (may result in tetany/seizures), hypernatremia, metabolic acidosis, and ischemic colitis.
## Key Drug Interactions
* **Diuretics:** May exacerbate the risk of dehydration and electrolyte imbalances.
* **Calcium Channel Blockers:** Increased risk of hyperphosphatemia-induced hypocalcemia.
* **NSAIDs/ACE Inhibitors/ARBs:** Increased risk of acute kidney injury through synergistic renal stress.
## Monitoring
* **Electrolytes:** Serum phosphate, calcium, sodium, potassium, and creatinine, particularly in patients with pre-existing renal disease or those using repeated doses.
* **Hydration:** Monitor for signs of clinical dehydration (e.g., dry mucous membranes, decreased urine output).
## Clinical Pearls
* Ensure the patient is in the correct position (left lateral decubitus) to facilitate administration.
* Lubricate the applicator tip before insertion to prevent mucosal trauma.
* If no bowel movement occurs after 30 minutes of administration, the patient should contact a healthcare provider to avoid excessive phosphate absorption.
* Not intended for chronic, long-term use.
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**Disclaimer:** This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications via reliable clinical databases (e.g., UpToDate, Lexicomp) before prescribing or administering.
