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# Sodium Phosphate Enema (e.g., Fleet Enema)
## Overview
A hypertonic saline laxative that works by osmotic effect, drawing water into the colon to stimulate peristalsis and evacuation. Onset of action is typically 2–15 minutes.
## Primary Indications
* Relief of occasional constipation.
* Bowel cleansing prior to rectal examinations or endoscopic procedures.
## Adult Dosing
* **Constipation:** 118 mL (one ready-to-use bottle) administered rectally as a single dose.
* **Max Frequency:** Do not exceed one dose in 24 hours.
## Pediatric Dosing
* **Children 2–11 years:** 59 mL (pediatric size) administered rectally as a single dose.
* **Children <2 years:** Use is not recommended due to high risk of severe electrolyte disturbances (hyperphosphatemia, hypocalcemia).
* **Max Frequency:** Do not exceed one dose in 24 hours.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Significant risk of hyperphosphatemia, hypocalcemia, hypernatremia, and hypokalemia. Avoid in patients with pre-existing renal disease or elevated creatinine.
* **Electrolyte Disorders:** Not recommended for patients with pre-existing electrolyte imbalances or those prone to dehydration.
## Contraindications
* Hypersensitivity to sodium phosphates.
* Congestive heart failure (due to sodium load).
* Clinically significant renal impairment.
* Bowel obstruction, megacolon, or suspected appendicitis.
* Acute surgical abdomen or inflammatory bowel disease (ulcerative colitis, Crohn’s).
## Adverse Effects
* **Common:** Rectal irritation, abdominal cramping, nausea.
* **Severe (Systemic):** Hyperphosphatemia, hypocalcemia (may lead to tetany or arrhythmias), hypernatremia, dehydration, metabolic acidosis, and acute phosphate nephropathy.
## Key Drug Interactions
* **Diuretics:** Increased risk of electrolyte imbalances (e.g., hypokalemia).
* **ACE Inhibitors/ARBs/NSAIDs:** Concurrent use may increase risk of acute phosphate nephropathy, particularly in patients with borderline renal function.
* **Calcium Channel Blockers:** Potential for exacerbated hypocalcemia.
## Monitoring
* **Electrolytes:** Baseline and post-administration serum phosphorus, calcium, potassium, sodium, and BUN/creatinine if patient is at high risk.
* **Hydration Status:** Monitor for signs of fluid volume deficit.
* **Renal Function:** Ensure adequate urine output post-procedure.
## Clinical Pearls
* **Positioning:** Patient should be in the left lateral decubitus (Sims) position to optimize flow.
* **Administration:** Lubricate the rectal tip prior to insertion. Do not force the enema; if resistance is encountered, stop immediately to avoid rectal perforation.
* **Patient Education:** Advise the patient that the urge to evacuate may occur almost immediately.
* **Safety Warning:** Deaths have occurred in patients with renal impairment or bowel obstruction; strict adherence to contraindications is mandatory.
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**Disclaimer:** This information is for educational purposes for healthcare professionals. Clinical protocols may vary by institution. Always verify specific dosing, safety information, and contraindications via official prescribing information or hospital-approved clinical guidelines before administration.
