The Fleet (registered name) enema is a hypertonic sodium phosphate solution widely used in patients with constipation. Some children are at risk for complications, which can be avoided by following guidelines for enema use.


Complications arising from excess absorption and/or decreased excretion of phosphate:

(1) hyperphosphatemia

(2) hypocalcemia

(3) hypokalemia

(4) metabolic acidosis

(5) dehydration

(6) hypernatremia

(7) cardiac arrest


Patients at risk for metabolic complications:

(1) renal disease (renal dysplasia, chronic renal failure)

(2) congenital or acquired intestinal disorders (imperforate anus, Hirschsprung's disease)

(3) children under 5 years of age


Guidelines to minimize the risk of complications:

(1) do not use in children under the age of 2 years

(2) do not use in children from 2 to 5 years of age with intestinal or renal disorders

(3) if stool impaction is present, disimpaction should be performed prior to use of the enema

(4) if a child is 2 to 5 years of age and if other methods have been tried unsuccessfully, then only a single Fleet administration should be used

(5) an alternative to Fleet enema is a saline enema given at a dose of 20 mL per kg body weight


Dose of Fleet Enema

child weighing 14 kg

30 mL

child weighing 27 kg

60 mL

child weighing 40 kg

90 mL


120 mL


If this data is analyzed in JMP, the following dose equation can be derived for patient up to 54 kilograms (with 120 mL supplied at higher weights):


volume of Fleet enema to use in mL =

= (2.2549 * (weight in kilograms)) - 1.102


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