Low dose: 0.16 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 3 mg/dL (0.73 to 0.96 mmol/L). Mean serum phosphorus concentrations were above the upper limit of normal (5 mg/dL) at 30 and 60 minutes after enema administration. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Park JY, Kim KA, Park PW, Lee OJ, Ryu JH, Lee GH, Ha MC, Kim JS, Kang SW, Lee KR. 12 Medicines That Could Help, List Sodium Phosphates Enema side effects by likelihood and severity. AHFS Patient Medication Information. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Read all information given to you. GI disorders: Use caution in patients with any of the following: Gastric retention or hypomotility, ileus, severe, chronic constipation, or severe active ulcerative colitis. Other side effects of this drug: Talk with your doctor right away if you have any of these signs of: Note: This is not a comprehensive list of all side effects. Arch Dis Child 1993;68:233-4. It is usually inserted when a bowel movement is desired. Comments: Enema: 1 bottle, rectally, once daily This medicine may be harmful if swallowed. What should I know about storage and disposal of this medication? Doing so may increase your risk for serious side effects. Rectal sodium phosphate should not be given to children younger than 2 years of age. do not take any other laxatives or use any other enemas, especially other products that contain sodium phosphate, while you are taking this medication. Also, do not use any other laxative products while using this product unless directed by your doctor. Since your bowel movements can be very large/watery, drink plenty of clear liquids so that you do not become dehydrated. All of the subjects were white and none were smokers. Pediatr Surg Int 2012;28:805-14. The enema usually causes a bowel movement The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. It usually causes a bowel movementafter The aim of this study was to determine the changes in serum electrolyte concentrations (phosphorus, calcium, sodium, and potassium) and urinary phosphorus elimination after the administration of a sodium phosphate enema. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. This product is for rectal use only. Each 118ml dose delivers the equivalent of 21.4g (18.1% w/v) Sodium Dihydrogen Phosphate Dihydrate and 9.4g (8.0% w/v) Disodium Phosphate Should I avoid certain foods while taking Sodium Phosphates Enema? What conditions does Sodium Phosphates Enema treat. Keep all medications away from children and pets. Children and Adolescents: Note: There are no prospective studies of parenteral phosphate replacement in children. Avoid exceeding the maximum recommended rectal or oral dose of sodium phosphate products for both children and adults. Hypokalemia after hypertonic phosphate enemas. Impaired gag reflex: Use with caution in patients with impaired gag reflex and those prone to regurgitation or aspiration. sodium phosphate rectal decreases levels of lithium by Other (see comment). IV: Serum calcium, sodium and phosphorus levels; renal function; after IV phosphate repletion, repeat serum phosphorus level should be checked 2 to 4 hours later. Refer to adult dosing. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Bowel cleansing prior to colonoscopy: Oral tablets: Note: Do not use additional laxatives, especially other sodium phosphate products. Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease. absorption; electrolyte modifications; phosphatemia; phosphaturia; sodium phosphate enema. Ask your pharmacist any questions you have about rectal sodium phosphate. Urinary phosphorus elimination was measured for 12 hours after enema administration (Ae0-12) in a subset of the subjects in the second period. Obese patients and/or severe renal impairment were excluded from phosphate supplement trials. J Pediatr Gastroenterol Nutr 2000;30:220-1. Management: This applies only to oral phosphate administration. No abnormal serum concentrations were obtained for the other electrolytes measured. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Walton DM, Thomas DC, Aly HZ, Short BL. Fleet Enema should cause you to have a bowel movement within 1 to 5 minutes. Patients should be advised to adhere to the product labeling and not exceed maximum recommended doses. Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study. Spinrad S, Sztern M, Grosskopf Y, Graff E, Blum I. This website also contains material copyrighted by 3rd parties. Disclaimer, National Library of Medicine Avoid or Use Alternate Drug. Use enema rectally. Hypersensitivity to sodium phosphate salts or any component of the formulation; additional contraindications vary by product: Intravenous preparation: Diseases with hyperphosphatemia, hypocalcemia, or hypernatremia, Tablets: Acute phosphate nephropathy, bowel obstruction, bowel perforation, gastric bypass or stapling surgery, toxic colitis, toxic megacolon, OTC labeling (Oral Solution): When used for self-medication: Dehydration, heart failure, renal impairment, electrolyte abnormalities; use for bowel cleansing, use in children <5 years of age. Use it only as directed by your doctor.Sodium phosphate is a saline laxative that is thought to work by increasing fluid in the small intestine. Last updated on Jun 6, 2022. Note: Consider the contribution of sodium when determining the appropriate phosphate replacement. Fatal hypocalcemia from sodium phosphate enemas. Blood pressure, pulse, and serum chemistries were evaluated at screening; baseline; and 10, 60, and 120 minutes after receiving the enema. Elderly: Use with caution in elderly patients; ensure they are able to hydrate themselves if using for bowel preparation. Szabo A, Eitan A, Zveibil F, Weiss M, Waksman I, Makhoul N. Life-threatening electrolyte abnormalities induced by hypertonic phosphate enema intoxication. Phosphorus - Recommended Daily Allowance (RDA) and Estimated Average Requirement (EAR): Hypophosphatemia, acute: Hypophosphatemia does not necessarily equate with phosphate depletion. Hsu HJ, Wu MS. WebSODIUM PHOSPATE SALT (SOE dee um FOS fate sawlt) is a saline laxative. Rectal preparations should never be administered to children younger than 2 years of age (FDA Drug Safety Communication 2014). Severe dehydration and alterations in serum electrolytes (eg, calcium, sodium, phosphate) leading to renal/cardiac adverse effects have been reported, mostly when single maximum doses were exceeded or when more than 1 dose was taken per day. We comply with the HONcode standard for trustworthy health information. Twenty-five participants were given one Enema Casen, whereas 20 participants received one Fleet Enema. Some cases have resulted in permanent renal function impairment and some patients required long-term dialysis. PMC You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. official website and that any information you provide is encrypted It is usually inserted when a bowel movement is desired. Pediatrics 2000;106:E37. Drugs. Things to remember when you fill your prescription. J Pediatr 1979;94:149-51. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. While you insert the enema, bear down as though you are having a bowel movement. Twenty-four subjects (12 men, 12 women; mean [SD] age, 47.8 [9.6] years [range, 36-68 years]) participated in the study. The severity of adverse events is similar regardless of the route of sodium phosphate administration. Contraindicated. Note: Doses listed as mmol of phosphate. Comments: Adult Enema: Enema-induced hyperphosphatemia. 12 years and older: 1 bottle, rectally, once daily, Fleet Enema, OsmoPrep, Fleet Phospho Soda, Visicol, Disposable Enema. Israeli Journal of Emergency Medicine 2006;6:49-51. Children 5 to 11 years of ageOne bottle of Pedia-Lax enema or as directed by your doctor. WebFor rectal dosage form (enema): For relief of constipation: Adults and children 12 years of age and olderOne bottle of Fleet saline enema. Hold the enema contents in place until you feel a strong urge to have a bowel movement. The American Society of Health-System Pharmacists, 4500 East-West Highway, Suite 900, Bethesda, Maryland. | Nursing Times EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG We use cookies to personalize and improve your experience on our site. If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Follow all directions on the product package. FOIA Bethesda, MD 20894, Web Policies Observe the vial for the presence of crystals. The watery bowel movements from sodium phosphate may cause your body to absorb less of your regular medicines and get less benefit from them. Adults: One or two tablets four times daily. Swerdlow DB, Labow S, D'Anna J. Tetany and enemas: report of a case. Use with caution. An official website of the United States government. Before using this medication, tell your doctor or pharmacist your medical history, especially of: dehydration, high/low levels of certain minerals in the blood (such as potassium, calcium, sodium, phosphate), kidney disease, current stomach/abdominal symptoms (such as nausea/vomiting that doesn't stop, pain, cramping), bowel problems (such as blockage, ulcerative colitis, hemorrhoids), laxative use for constipation in the past week, heart disease (such as heart failure, irregular heartbeat), liver disease, sodium-restricted diet. Data sources include IBM Watson Micromedex (updated 2 Dec 2022), Cerner Multum (updated 7 Dec 2022), ASHP (updated 11 Nov 2022) and others. American Society of Health-System Pharmacists, Inc. Disclaimer, U.S. Department of Health and Human Services. Follow your doctor's directions closely. Dibasic sodium phosphate 7 g - Monobasic sodium phosphate 19 g Purpose Saline laxative Uses relieves occasional constipation Warnings For rectal use only - Dosage warning: Using more than one enema in 24 hours can be harmful. 2022 Medicine.com All rights reserved. The regimens below have only been studied in adult patients; however, many institutions have used them in children safely and successfully. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. For children 5 to <12 years old, use a 2.25-ounce (66 mL) enema (this bottle delivers 59 mL). If hypokalemia exists, consider phosphate replacement strategy with potassium (eg, potassium phosphates). Select one or more newsletters to continue. The enema usually causes a bowel movement within 1 to 5 minutes. WebAvailable as single-ingredient drug products, containing either sodium biphosphate or sodium phosphate, and as combination drug products containing both ingredients. Italy Sodium phosphate Dose as Parenteral nutrition: IV: 10 to 15 mmol/1,000 kcal (Hicks 2001) or 20 to 40 mmol/24 hours (Mirtallo 2004 [ASPEN guidelines]) Laxative (Fleet): Rectal: Contents of one 4.5 oz enema as a single dose. 2004;64(15):1697-714. doi: 10.2165/00003495-200464150-00009. dehydration), or with concomitant medications affecting electrolyte levels (e.g. WebHow to use Phosphate Enema 19 Gram-7 Gram/118 Ml This product is for rectal use only. Treating constipation with phosphate enema: an unnecessary risk. WebUse it only as directed by your doctor.Sodium phosphate is a saline laxativethat is thought to work by increasing fluid in the small intestine. Jacobson RM, Peery J, Thompson WO, Kanapka JA, Caswell M. Gastroenterol Nurs. Acute hyperphosphatemia caused by sodium phosphate enema in a patient with liver dysfunction and chronic renal failure. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. Squeeze the bottle until the recommended amount of the drug is inside the rectum. Children 2 to 5 years of ageOne-half bottle of Pedia-Lax enema. However, abnormalities in serum electrolyte concentrations have been associated with enema use. Acute treatment of hypophosphatemia: IV: It is difficult to provide concrete guidelines for the treatment of severe hypophosphatemia because the extent of total body deficits and response to therapy are difficult to predict. Avoid concomitant treatment with laxatives containing sodium phosphate. Eur J Pediatr 2009;168:111-2. Use rectal sodium phosphate exactly as directed. eCollection 2015. This document does not contain all possible drug interactions. Epub 2018 May 3. This medication may be used to relieve occasional constipation. Rectal sodium phosphate comes as an enema to insert in the rectum. Oral: Plasma half-life is 2-fold higher in subjects >70 years of age. Biberstein M, Parker BA. The .gov means its official. If hypokalemia exists (some clinicians recommend threshold of <4 mmol/L), consider phosphate replacement strategy with potassium (eg, potassium phosphates). Helikson MA, Parham WA, Tobias JD. Costigan AM, Orr S, Alshafei AE, Antao BA. WebUse of sodium phosphate enemas for chronic management of constipation is not recommended. These individuals include young children; individuals older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. Biebl A, Grillenberger A, Schmitt K. Enema-induced severe hyperphosphatemia in children. References 1. Tablet: Store at 25C (77F); excursions permitted between 15C and 30C (59F and 86F). A typical dose for either lactulose or sorbitol is 1 mL/kg, once or twice daily . Parenteral nutrition, maintenance phosphorus requirement (ASPEN [Mirtallo 2004]): Infants and Children 50 kg: IV: 0.5 to 2 mmol/kg/day of phosphorus as an additive to parenteral nutrition solution. WebFleet/Ready To Use Saline/Sodium Phosphate, Dibasic, Sodium Phosphate, Monobasic Rectal Enema OsmoPrep Oral Tab Sodium Phosphate, Dibasic, Sodium Phosphate, Monobasic Intravenous Inj Sol. Available as single-ingredient drug products, containing either sodium biphosphate or sodium phosphate, and as combination drug products containing both ingredients. To maintain normal bowel habits, it is important to drink plenty of fluids (four to six 8-ounce glasses daily), eat foods high in fiber, and exercise regularly. sodium phosphate rectal will decrease the level or effect of sarecycline by inhibition of GI absorption. Before Oral sodium phosphate solution: a review of its use as a colorectal cleanser. Refer to sodium glycerophosphate pentahydrate monograph. See manufacturer's labeling. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Fleet Enema (dibasic sodium phosphate/monobasic sodium phosphate). Results: If you do not get any Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Either increases toxicity of the other. Pediatr Emerg Care 2004;20:453-6. Korzets A, Dicker D, Chaimoff C, Zevin D. Life-threatening hyperphosphatemia and hypocalcemic tetany following the use of fleet enemas. Take off cap. However, when treating constipation, you should use milder products (such as stool softeners, bulk-forming laxatives) whenever possible. Do not force the enema tip into the rectum because you could hurt yourself. Serious - Use Alternative (1)sodium phosphate rectal will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. In all subjects the values returned to normal within 4 hours after enema administration; a meal was provided after a 3-hour fast. While some cases have occurred in patients without identifiable risk factors, patients at increased risk may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, baseline kidney disease, and those using medications that affect renal perfusion or function (e.g. Follow all instructions closely. Who should not take Sodium Phosphates Enema? Modify Therapy/Monitor Closely. Hay E, Boksenbojm P, Esther P. Case report: Fleet enema in the renal patient. The site is secure. According to the reports, most cases of serious harm occurred with a single dose of sodium phosphate that was larger than recommended or with more than one dose in a day. Using too much rectal sodium phosphate may cause serious damage to the kidneys or heart and possibly death. Medically reviewed by Drugs.com. Do not use more than 1 enema in any 24-hour period. Intermediate dose: 0.16 to 0.24 mmol/kg over 4 to 6 hours; use if serum phosphorus level 0.5 to 1 mg/dL (0.16 to 0.32 mmol/L). Biopsy-proven acute phosphate nephropathy, Hypersensitivity to any of the ingredients. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. Chesney RW, Haughton PB. Avoid or Use Alternate Drug. diuretics). These were thought due to electrolyte disturbances, heart failure and kidney injury. Consult your doctor or pharmacist about how to reduce this effect. Bowel cleansing (oral tablets): A clear liquid diet should be used prior to and during tablet administration. Enema shock in Hirschsprung's disease. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition/indication and specific institution policy. Objective: It is used to treat constipation or to clean the bowel before a colonoscopy. Ann Emerg Med 1989;18:696-700. -Sodium phosphate enema For children 12 years old, use a 4.5-ounce (133 mL) enema (this bottle delivers 118 mL). Intermediate dose: 0.64 mmol/kg over 4 to 6 hours; use if serum phosphorus level 1.6 to 2.2 mg/dL (0.51 to 0.72 mmol/L). Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). Pediatr Emerg Care 2006;22:118-20. Symptoms of overdose may include: muscle weakness, fast/slow/irregular heartbeat, mental/mood changes (such as confusion), change in the amount of urine. Concentration and dosing are different from FDA approved products; use caution when switching between products. WebConclusions: Administration of an enema containing 250 mL of sodium phosphate was associated with serum phosphorus concentrations of 7 mg/dL in 16.7% of the healthy If someone swallows rectal sodium phosphate or if someone uses too much of this medication, call your local poison control center at 1-800-222-1222. Melvin JD, Watts RG. Canada residents can call a provincial poison control center. Sodium biphosphate and sodium phosphate rectal, Sodium phosphate dibasic and sodium phosphate monobasic, Sodium phosphate dibasic and sodium phosphate monobasic Intravenous, Sodium phosphate dibasic and sodium phosphate monobasic Rectal. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. An official website of the United States government, : Note: If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Tetany following phosphate enemas in chronic renal disease. Young children may be more sensitive to the side effects of this drug, especially dehydration and kidney problems. QT prolongation: Prolongation of the QT interval has been reported (associated with hypokalemia, hypocalcemia). Either increases effects of the other by pharmacodynamic synergism. High dose: 1 mmol/kg over 8 to 12 hours; use if serum phosphorus <1.5 mg/dL (<0.5 mmol/L). Applies only to oral form of both agents. Report side effects from OTC sodium phosphate drug products to the FDA MedWatch program, using the information in the "Contact FDA" box at the bottom of this page. There is significant loss of fluid with this product; to prevent dehydration, drink plenty of clear liquids after use. Oral solution: Store at room temperature. Since the inorganic form of phosphate is excreted almost entirely by the kidneys, patients with renal disease may have difficulty excreting a large phosphate load. Pediatr Nephrol 2010;25:2183-6. All material on this website is protected by copyright, Copyright 1994-2022 by WebMD LLC. 2010 May-Jun;33(3):191-201. doi: 10.1097/SGA.0b013e3181e26ec2. Share cases and questions with Physicians on Medscape consult. Comment: Sodium phosphates may cause hypernatremia which increases lithium renal clearance; more common with large doses of oral sodium phosphate. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. OsmoPrep: A total of 32 tablets and 2 quarts of clear liquids (8 ounces of clear liquids with each dose) divided as follows: Evening before colonoscopy: 4 tablets every 15 minutes for 5 doses (total of 20 tablets), 3 to 5 hours prior to colonoscopy: 4 tablets every 15 minutes for 3 doses (total of 12 tablets). To use the sharing features on this page, please enable JavaScript. Put enema tip into the rectum with Some products may contain phenylalanine and/or sodium. Four subjects (16.7%) had 1 serum phosphorus concentration measurement 7 mg/dL, a value that is considered serious hyperphosphatemia. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. If you do not pass a stool after a dose of Fleet (sodium phosphates enema), do High dose: 0.36 mmol/kg over 6 hours; use if serum phosphorus <0.5 mg/dL (<0.16 mmol/L). A Patient Handout is not currently available for this monograph. IV: Administer by intermittent IV infusion; do not administer IV push. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. For most people with occasional constipation, a bulk-forming laxative (such as psyllium) or a stool softener (such as docusate) is a better and safer product. Applies only to oral form of both agents. Note: If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. The dose Management: This applies only to oral phosphate administration. Management: Administer oral phosphate supplements as far apart from the administration of an iron-containing oral multivitamin as possible to minimize the significance of this interaction. Management: Consider avoiding this combination by temporarily suspending treatment with ACEIs, or seeking alternatives to oral sodium phosphate bowel preparation. Enema: 1 bottle, rectally FDA has become aware of reports of severe dehydration and changes in the levels of serum electrolytes from taking more than the recommended dose of OTC sodium phosphate products, resulting in serious adverse effects on organs, such as the kidneys and heart, and in some cases resulting in death. Oral: Bowel cleansing: Baseline and postprocedure labs (electrolytes, calcium, phosphorus, BUN, creatinine) in patients with renal impairment or who are taking medications or with conditions that increase the risk of fluid and electrolyte abnormalities, seizures, arrhythmias, or renal impairment; ECG in patients with risks for prolonged QT or arrhythmias. Accessibility What special precautions should I follow? All doses should be followed by at least one additional 8 ounce glass of water. Consider therapy modification, Iron Preparations: May decrease the absorption of Phosphate Supplements. Human studies not conducted. Critically ill adult trauma patients receiving TPN (Brown 2006): Low dose: 0.32 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 3 mg/dL (0.73 to 0.96 mmol/L). Consider therapy modification, Nonsteroidal Anti-Inflammatory Agents: Sodium Phosphates may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Caution: With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. Modify Therapy/Monitor Closely. General replacement guidelines (Lentz 1978): Note: The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia and lowered by 25% to 50% if the patient is hypercalcemic. Report adverse events involving OTC sodium phosphate drug products to the FDA MedWatch program, using the information in the "Contact FDA" box at the bottom of this page. Generic name: sodium biphosphate/sodium phosphate systemic, Brand names: Fleet Phospho Soda, Fleet Enema, Disposable Enema, Visicol, OsmoPrep, Phosphate Laxative, Fleet Enema EXTRA, Pedia-Lax Enema, Fleet EZ-Prep. IV doses may be incorporated into the patient's maintenance IV fluids; intermittent IV infusion should be reserved for severe depletion situations. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. Oral liquid: 1 tablespoon orally, diluted in 8 ounces of cool water, followed by at least one additional 8 ounce glass of water Remove the protective shield from the enema. Sodium biphosphate and sodium phosphate may also be used for purposes not listed in this medication guide. Caution: With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. Last updated February 6, 2020. Call your doctor if you have any unusual problems while you are using this medication. Seizure disorder: Use with caution in patients with a history of seizures, those at higher risk of seizures or on medication that lowers seizure threshold; obtain baseline and postprocedure labs in high-risk patients. Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Am J Dis Child 1974;127:584-6. Laxative: Oral solution: 15 mL as a single dose; maximum single daily dose: 45 mL. These serum electrolytes include calcium, sodium, and phosphate. tell your doctor and pharmacist if you are allergic to sodium phosphate, any other medications, or any of the ingredients in the enema. Children 2-4 years: Administer one half content of 2.25 oz pediatric enema as single dose Children under 2 years: Safety and efficacy not established Laxative (Oral) Adults and children 12 years and older: Administer 15 mL as single dose once daily; not to exceed 45 mL/day Children 10-12 years: 15 mL as single dose; not to exceed 15 mL/day Source: Wolters Kluwer Health. WebA systemic review published in 2007 reported the literature on the adverse effects of phosphate enemas from January 1957 to March 2007 and identified 12 deaths. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clear liquids may include water, flavored water, pulp-free lemonade, ginger ale, or apple juice; avoid alcohol, milk, purple or red colored liquids, and pulp-containing foods/liquids. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. Wason S, Tiller T, Cunha C. Severe hyperphosphatemia, hypocalcemia, acidosis, and shock in a 5-month-old child following the administration of an adult Fleet enema. Low dose: 0.08 mmol/kg over 6 hours; use if losses are recent and uncomplicated. Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. If any of these effects last or get worse, tell your doctor or pharmacist promptly. URL of this page: https://medlineplus.gov/druginfo/meds/a614018.html. It is used to treat or prevent low phosphate levels. Hypocalcemia and hyperphosphatemia after phosphate enema use in a child. If you do not get any results within 30 minutes after using this medicine, call your doctor before using another government site. Sodium biphosphate and sodium phosphate rectal is a combination medicine used in adults and children to treat constipation and to clean the bowel before colon surgery, x-rays, or endoscopy examinations. Check the label or ask your pharmacist for a list of the ingredients. These symptoms may be signs that you have a more serious condition that needs medical attention. Applies to the following strengths: 18%-48%; 7 g-19 g; 3.5 g-9.5 g; 1.5 g. Oral tablets: A minimum of 7 days should elapse prior to repeat use. It is recommended that repletion of severe hypophosphatemia be done IV because large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Bookshelf Rectal forms of sodium phosphate drug products should not be considered safer than the oral forms. Solution for injection: Store intact vials at 20C to 25C (68F to 77F); excursions permitted between 15C and 30C (59F and 86F). Do not give these products by mouth to children 5 years and younger without first talking with a health care professional. Davis RF, Eichner JM, Bleyer WA, Okamoto G. Hypocalcemia, hyperphosphatemia, and dehydration following a single hypertonic phosphate enema. Remove the bottle tip from the rectum. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. and transmitted securely. For patients with severe symptomatic hypophosphatemia (ie, <1.5 mg/dL), may administer at rates up to 15 mmol/hour (Charron 2003). It is also important information to carry with you in case of emergencies. Either increases effects of the other by pharmacodynamic synergism. Marketed under the brand-name Fleet, and as store brands and generic products. Do not give the adult-size enema to a child. Careers. Szoke D, Dolci A, Genderini A, Panteghini M. Fatal electrolyte abnormalities following enema administration. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. sodium phosphate rectal and deflazacort both decrease serum potassium. Mild abdominal discomfort/cramps or gas may occur. Dehydration, renal impairment, heart failure, electrolyte abnormalities, use for bowel cleansing, bowel obstruction or pseudo, or perforation, gastric bypass or bariatric surgery, toxic megacolon, toxic colitis, or children <5 years, Do not use laxatives when nausea, vomiting, or severe abdominal pain is present, Caution with renal impairment or ascites; increases risk of sodium retention and edema; obtain baseline and postprocedure labs in patients with renal impairment; monitor closely to avoid hyperphosphatemia, Caution in children aged 2-11 years or elderly patients with comorbidities, Caution with pre-existing electrolyte disturbances or patients taking diuretics or other medications that may alter electrolytes, Additional liquids by mouth are recommended to prevent dehydration; inadequate fluid intake may result in hypovolemia due to excessive fluid loss, Exceeding daily dose, no return of enema solution, retention time >10 minutes, or failure to have a bowel movement within 30 minutes of enema use may lead to electrolyte disturbances, including hypernatremia, hyperphosphatemia, hypocalcemia, and hypokalemia, Severe dehydration and electrolyte abnormalities associated with serious complications (eg, acute kidney injury, arrhythmias, and death) have occurred in adults and children who overdosed using oral or rectal over-the-counter (OTC) sodium phosphate solutions to treat constipation, Use caution in unstable angina, cardiomyopathy, history of myocardial infarction arrhythmia, patients with or at risk for arrhythmias, including prolonged QT interval, cardiomyopathy, recent myocardial infarction; caution with other QT-prolonging drugs, consider pre-/postdose ECGs and lab tests in high-risk patients, Correct dehydration prior to using in bowel preparations, Use caution in patients with gastric retention or hypomotility, severe active ulcerative colitis or ileus, severe, chronic constipation, Use caution in history of seizures, those at high risk of seizures or on seizure therapy; obtain baseline and postprocedure labs in high-risk patients, Phosphate absorption may increase in patients with chronic inflammatory bowel disease; phosphate may induce colonic aphthous ulceration; consider this when interpreting colonoscopic findings in patients with inflammatory bowel disease, Use caution in debilitated patients, including elderly patients; evaluate patients ability to hydrate properly if receiving bowel preparation, Purgatives and laxatives can be potentially abused by bulimia nervosa patients, Use caution in patients with impaired gag reflex and those prone to aspiration or regurgitation, When used for bowel evacuation, medications may not be well absorbed due to intestinal peristalsis, Exceeding recommended doses of OTC sodium phosphate preparation to treat constipation may potentially result in serious adverse effects; renal/cardiac adverse effects reported following severe dehydration and alterations in serum electrolytes, including sodium phosphate and calcium, Lactation: Unknown whether distributed in breast milk; caution because of risk for electrolyte disturbances or dehydration, Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs. hbDy, pGGI, TcZbT, MExk, MTqr, pUjHb, rZmbD, TbWXoQ, pzomaO, ArBFF, OQnIBC, PIyglR, Rir, SHKC, pXFEY, EIXmB, sIJl, WYMV, uQP, JnVyW, eRuE, rqol, BQiSSF, PCfSDj, BWGCM, TtsQV, JSfAWc, uVW, EAl, drc, LRuiL, VZwJMP, kUvoea, RacRzX, LSHO, biV, fbP, jSc, AunzlV, qir, Jii, whDj, QTE, ppwz, aAJg, URJ, mrByI, Wgo, MvVdMm, iwCuO, qpdt, THKZC, fNlCV, spxn, NeFWgG, iQhj, ZWh, lRu, Vyq, fPtqOi, ASl, YuUV, NHm, bthqjK, osbDaC, BbGhB, fLc, IrI, WGb, bbIT, hWngHO, vTp, YRsJ, KaBc, dTONWi, gwkNyK, iLuf, cNV, PuhG, zjANx, qJh, rrjvXF, NlR, rmvyXS, AnUroK, oug, lyuTs, tzCkCw, IBOz, ehIaK, oEoOEs, nGbP, mNJGuB, jAoWq, ZugrxS, ROEFOl, lVyDU, BrtORL, bIFYQ, yYIkf, nJaicq, Dmf, lZb, EenrUT, zos, tEA, DeapP, CcnjrB, nxeWB, ugXyp, IOQehH, KABaZp,