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We use sodium phosphates rectal solution (our hospital’s generic equivalent to Fleet enema) as an additive to the acid bath when we need supplemental phosphate in our 3x/week hemodialysis patients. We have no policy outlining dose or monitoring. The nephrologists order by ml of solution to be added and we monitor by serum PO4 labwork. Doses range from 60-120ml and are adjusted in 30ml increments based on labwork. We have had patients on this for periods of a few treatments up to as long as a few months.