Hypocalcemic Coma Following Two Pediatric Phosphate Enemas

Colonoscopy is a routinely performed procedure in children and adolescents. Proper visualization of the intestinal mucosa, completion of the procedure, including examination of the terminal ileum, detection of pathological lesions, and therapeutic maneuvers, all are highly dependent on the quality of the bowel preparation. A significant proportion of patients, in some reports up to one third, are inadequately prepared for the examination, which leads to extended procedure time, incomplete examination, or need for repeat procedure. Aside from efficacy and safety, the most important aspects of colon preparation in pediatrics are ease of administration, palatability, dietary restriction, and minimization of disruption of daily routine. An ideal preparation does not exist and a wide variety of regimens are being used. Several of these have been investigated in pediatric clinical trials. This article reviews the published literature with an emphasis on the most commonly used agents, their mechanism of action, efficacy and ease of use, and safety.

Section: Safetymentioning

confidence: 99%

Bowel Preparation for Pediatric Colonoscopy Procedures

Hunter

Mamula

2010

“…Sodium phosphate enemas have had significant side effects in children with renal insufficiency (5) and in young infants (6,7). Hypocalcemia and tetany using sodium phosphate enemas in a child with mylomeningocele and urinary infection has been reported (8). Our study excluded children <2 years old and could not be used to justify the use of this preparation in such patients.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy Preparation in Children: Safety, Efficacy, and Tolerance of High‐ Versus Low‐Volume Cleansing Methods

da Silva,

Briars,

Patrick

et al. 1997

Background:The use of large‐volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high‐versus low‐volume colon‐cleansing methods as preparation for colonoscopy in children were compared by randomized operator‐blinded trial.Methods:Twenty‐nine children ages 3.6‐14.6 years had either high‐volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5‐45 ml) separated by oral fluid intake (n = 14).Results:Both preparations were equally effective. The low‐volume preparation was better tolerated and caused less discomfort that the high‐volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal.Conclusions:There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less‐invasive oral sodium phosphate low‐volume colon‐cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.

“…Risk factors for complications of sodium phosphate enemas in children include Hirschsprung's disease (14), fecal retention (15), poor urinary phosphate clearance due to renal failure (16), and excessive doses in previously healthy children (17,18). The symptoms occurring in the children in previous reports were due to associated electrolyte abnormalities such as hypocalcemia (14‐18) or hypokalemia (19). The lack of symptoms in patients in the present report is probably owing to the lack of clinically significant abnormalities in other electrolytes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oral Sodium Phosphate to Polyethylene Glycol‐Based Solution for Bowel Preparation for Colonoscopy in Children

Gremse,

Sacks,

Raines

1996

SummaryThirty‐four patients, aged 3 to 17 years, were randomized to receive oral sodium phosphate solution or a polyethylene glycol‐based solution in preparation for elective colonoscopy. Nineteen patients received two doses of oral sodium phosphate solution (45 mL/1.7 m2/dose) and 15 received polyethylene glycol‐based solution (4 L/1.7 m2). Compliance with oral sodium phosphate solution was judged as easy or tolerable in 15 of 19 patients, but only in 5 of 15 who were given polyethylene glycolbased solution. The quality of colon cleansing was rated by an endoscopist who was blinded to the colon preparation method used. The bowel preparation was excellent or good (only liquid remaining in the colonic lumen) in 18 of 19 patients who received oral sodium phosphate solution and in 6 of 15 who received polyethylene glycol‐based solution. The incidence of vomiting was similar in both groups, but abdominal pain occurred more frequently in the polyethylene glycol‐based solution group. Hyperphosphatemia developed in patients who received oral sodium phosphate solution (serum phosphorus = 2.3 ± 0.7 mmol/L (7.2 ± 2.2 mg/dL; mean ± SD), but only in 1 of 15 patients in the polyethylene glycol‐based solution group. Patients did not exhibit symptoms of hyperphosphatemia and serum calcium concentrations were similar in both groups. In summary, oral sodium phosphate solution is better tolerated than polyethylene glycol‐based solution for bowel preparation in children. However, hyperphosphatemia occurred frequently in patients who received oral sodium phosphate solution. Further studies are needed to determine the optimal dose for safety and efficacy for the use of these solutions in children.