SODIUM PHOSPHATES

BRAND NAMES:
Fleet® Enema [OTC]; Fleet® Phospho®-Soda [OTC]; Fleet® Phospho-Soda® Accu-Prep™ [OTC]; Visicol™

AVAILABLE FORMS:
Enema: Monobasic sodium phosphate 19 g and dibasic sodium phosphate 7 g per 118 mL delivered dose (135 mL)
Fleet® Enema: Monobasic sodium phosphate 19 g and dibasic sodium phosphate 7 g per 118 mL delivered dose (135 mL)
Fleet® Enema for Children: Monobasic sodium phosphate 9.5 g and dibasic sodium phosphate 3.5 g per 59 mL delivered dose (68 mL)
Injection, solution [preservative free]: Phosphate 3 mmol and sodium 4 mEq per mL (5 mL, 15 mL, 50 mL)
Fleet® Phospho®-Soda: Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL (45 mL, 90 mL) [contains sodium benzoate; unflavored or ginger-lemon flavor]
Fleet® Phospho-Soda® Accu-Prep™ [kit]: Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL (15 mL) [solution contains sodium benzoate; kit contains solution in six 15 mL unit-dose containers (equal to two 45 mL doses) plus 4 anorectal pads containing pramoxine hydrochloride 1% and glycerin 12%]
Tablet, oral (Visicol™): Sodium phosphate monobasic monohydrate 1.102 g and sodium phosphate dibasic anhydrous 0.398 g [1.5 g total sodium phosphate per tablet]

INDICATIONS:
Short-term treatment of constipation and to evacuate the colon for rectal and bowel exams
I.V.: Source of phosphate in large volume I.V. fluids and parenteral nutrition; treatment and prevention of hypophosphatemia

ADVERSE REACTIONS:
Cardiovascular: Edema, hypotension
Central nervous system: Dizziness, headache
Endocrine & metabolic: Hypocalcemia, hypernatremia, hyperphosphatemia, calcium phosphate precipitation
Gastrointestinal: Nausea, vomiting, diarrhea, abdominal bloating, abdominal pain, abdominal cramping, mucosal bleeding, superficial mucosal ulcerations
Renal: Acute renal failure

MECHANISM OF ACTION:
Sodium Phosphates Injection, USP, 3 mM P/mL (millimoles/mL), is a sterile, nonpyrogenic, concentrated solution containing a mixture of monobasic sodium phosphate and dibasic sodium phosphate in water for injection. Sodium is the principal cation of extracellular fluid. It comprises more than 90% of the total cations at its normal plasma concentration of approximately 142 mEq/liter. While the sodium ion can diffuse across cell membranes, intracellular sodium is maintained at a much lower concentration than extracellular sodium through the expenditure of energy by the cell (so called “sodium cation pump”). Loss of intracellular potassium ion is usually accompanied by an increase in intracellular sodium ion.
Phosphorus in the form of organic and inorganic phosphate has a variety of important biochemical functions in the body and is involved in many significant metabolic and enzyme reactions in almost all organs and tissues. It exerts a modifying influence on the steady state of calcium levels, a buffering effect on acid-base equilibrium and a primary role in the renal excretion of hydrogen ion.
As a laxative, exerts osmotic effect in the small intestine by drawing water into the lumen of the gut, producing distention and promoting peristalsis and evacuation of the bowel; phosphorous participates in bone deposition, calcium metabolism, utilization of B complex vitamins, and as a buffer in acid-base equilibrium

CONTRAINDICATIONS:
Hypersensitivity to sodium phosphate salts or any component of the formulation; congenital megacolon, toxic megacolon, bowel obstruction, bowel perforation, imperforate anus (enema), congestive heart failure, ascites.
Sodium phosphate is contraindicated in diseases where high phosphorus or low calcium levels may be encountered, and in patients with hypernatremia.
Oral: Should not be used in patients with kidney disease, unstable angina pectoris, gastric retention, ileus, acute obstruction or pseudo-obstruction, severe chronic constipation, acute colitis, or hypomotility syndrome.

EFFECTS ON LAB TEST RESULT:
May increase sodium and phosphate levels. May decrease electrolyte level, with prolonged use.

NURSING CONSIDERATIONS:
1. This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.
2. Store at 20 to 25°C (68 to 77°F).
3. Intravenous preparation: Must be diluted before use; infuse slowly.
4. Should be taken on an empty stomach with water; a clear liquid diet should be used for 12 hours prior to tablet administration.
5. Do not use recommended dose more than once in 24 hours.
6. Maintain adequate fluid intake.
7. Teach patient about dietary sources of bulk, including bran and other cereals, fresh fruits and vegetables.
8. Use cautiously in clients with large hemorrhoids or anal excoriations.
9. Dosages are expressed as sennosides.
10. before giving drug for constipation, determine whether patient has adequate fluid intake, exercise and diet.