I have encountered the use of Fleets enema in the elderly a few times.  One of the most important things to look for when using this medication is kidney function.  The FDA did issue warnings for the oral preparation of this sodium phosphate to treat constipation, but Fleets enema is still available over the counter.

So what is the risk and should we use this medication?

The risk of using Fleets enema in the elderly is that it has the potential of causing acute hyperphosphatemia.  There has been much stronger evidence in regards to the oral product which prompted the FDA warning, but there have been case reports of hyperphosphatemia and acute renal failure due to use of the enema form of sodium phosphate.

Should we use Fleets enema in our elderly population? Looking at a patients kidney function is going to be one of the first things I would identify as a potential risk.  The worse their kidney function the less likely I would consider it as an option.

Frequency of use is going to be another important factor.  Is or has the patient been using this frequently or is it anticipated that they will only use it on a one time basis.

The other important factor here in patients who may be at some risk of this rare adverse effect would be to look at the other alternatives that have been tried.

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