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Fleets Enema

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Fleets Enema, Fleet Enema, Phospho-Soda, Pink Lady Enema, Sodium Phosphate Enema, Sodium phosphate, OsmoPrep

  • See Also
  1. Osmotic Laxative
  2. Laxative
  3. Constipation
  4. Functional Constipation
  5. Pediatric Constipation
  • Indications
  1. Functional Constipation
  2. Colonoscopy preparation
  • Contraindications
  1. Renal Failure
  2. Hyperphosphatemia
  3. Hypocalcemia
  4. Hypokalemia
  5. Hypernatremia
  6. Toxic Megacolon
  7. Intestinal Obstruction
  • Mechanism
  1. Poorly absorbed, hyperosmolar agents
    1. Increases intestinal retention of water, stimulating stool passage
    2. Also, increases renal excretion of Hydrogen Ion, in place of the reabsorption of Sodium ions
  • Complications
  1. Hypocalcemia (phosphate Overdose)
  1. Phopho-Soda (OsmoPrep, Visicol) 2 tablespoons in 4 ounces water orally
  2. Fleets Enema (Sodium phosphate) 133 ml enema (adult) or 66 ml enema (pediatric)
  3. Pink Lady Enema (1/2 Fleet Enema, 100 ml Docusate, 60 ml Mineral Oil, 60 ml Magnesium Citrate)
  4. Alternative agents
    1. Tap Water Enema
  • Dosing
  • Sodium Phosphate Enema
  1. General
    1. Onset of action: 2 to 5 minutes
    2. Attempt to retain enema for 15 to 30 minutes before stooling
  2. Adults (and age >12 years)
    1. One adult enema (133 ml) per Rectum
    2. Sodium phosphate may be used orally up to 45 ml/24 hours
      1. Risk of serious Electrolyte abnormalities or Renal Failure with higher doses or recurrent use
  3. Children: 2.5 ml/kg (up to 133 ml/dose)
    1. Avoid in age <2 years
    2. Age 2 to 4 years: 33 ml (1/2 pediatric enema) per Rectum
    3. Age 5 to 11 years: 66 ml (one pediatric enema) per Rectum
  • Dosing
  • OsmoPrep
  1. Indicated prior to Colonoscopy
  2. Dispense 32 OsmoPrep tabs (1.5 g/tab)
  3. Evening before procedure
    1. Take 4 tabs orally with 8 oz clear fluid every 15 min for total of 20 tabs (5 doses in 75 min, 40 oz fluid)
  4. Day of procedure (starting 3 to 5 hours before)
    1. Take 4 tabs orally with 8 oz clear fluid every 15 min for total of 12 tabs (3 doses in 45 min, 24 oz fluid)
  1. Place Foley Catheter inserted into Rectum and slowly inflated
  2. Infuse enema liquid into Foley Catheter using Toomey syringe
  3. Tilt head of bed down to 15 to 30 degrees (trendelenburg position)
  4. Leave the Foley Catheter and balloon in place for 15 to 20 minutes to allow adequate enema retention time
  5. Prepare for rapid outflow of stool contents (pads and other protection on bed)
  6. Deflate the balloon and remove the Foley Catheter (standing to side)
  7. Fisher and Swaminathan in Swadron (2022) EM:Rap 22(11): 7-8
  • Adverse Effects
  1. Acute phosphate nephropathy (FDA Black Box Warning)
    1. Risk of permanent impact on Renal Function following use
    2. Risk Factors
      1. Diabetes Mellitus
      2. Age over 65 years
      3. Dehydration
      4. Concurrent NSAID, ACE Inhibitor, ARB or Diuretic
    3. Prevention of Renal Function impact
      1. Consider alternative Bowel Preparation if risk factors above
      2. Maintain clear fluid intake to replace fluid losses from Diarrhea
  2. Rectal Wall Trauma
  3. Abdominal Pain
  4. Abdominal Distention
  5. Nausea
  6. Hyperphosphatemia
  7. Hypocalcemia
  8. Hypokalemia
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation (but not typically absorbed)
  • Drug Interactions
  1. Agents that decrease renal perfusion
    1. ACE Inhibitors
    2. Angiotensin Receptor Blockers
    3. Diuretics
    4. NSAIDs
  • Resources
  1. Sodium Phosphate Enema
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d73165f9-5203-4888-8af8-822c470933b3
  • References
  1. (2023) Management of Constipation, Presc Lett, #390108
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia