Severe Hyperphosphatemia and Hypocalcemia Following the Rectal Administration of a Phosphate-Containing Fleet® Pediatric Enema

Abstract

Osmotically acting hypertonic phosphate enemas can result in severe toxicity if retained. This is true even in patients without predisposing risk factors.

Forensic application of ESEM and XRF-EDS techniques to a fatal case of sodium phosphate enema intoxication

“…1), were indicative of an acute alteration of the fluid and electrolyte equilibria. Although setting the suspicion of a massive absorption of a hypertonic solution containing sodium phosphate with hyperphosphatemia, intracellular and extracellular calcium phosphate binding, and consequent hypocalcemia, the hypernatremia and the hypocalcemia alone could not prove the administration of a hypertonic enema [10,11].…”

Phosphatintoxikation nach Klysmagabe – eine lebensgefährliche iatrogene Komplikation

“…Während das aus Natriumhydrogencarbonat freigesetzte CO2 über einen Dehnungsreiz den Defäkationsreflex stimuliert, bewirken Glycerol, Bisacodyl, Phosphatsalze oder Sorbitol letztlich eine Flüssigkeitsansammlung im Darmlumen, was zu einem Aufweichen der harten Stuhlmassen im Rektum führt, die Rektummotilität fördert und damit eine Stuhlentlee rung ermöglicht [17]. Phosphathaltige Klysmen sind für Säuglinge, Kleinkinder und jüngere Kinder nicht geeignet, da sie zu Hyper phosphatämien mit fatalem Ausgang führen können [4,7,9,10,16]. Besonders junges Patientenalter (< 5 Jahren) und gast rointestinale sowie renale Comorbiditäten wurden als Risiko faktoren identifiziert [11].…”

Enema-induced severe hyperphosphatemia in children

“…The accepted opinion is that the phosphate in these enemas is poorly absorbed; however, our clinical experience suggests otherwise. Significant morbidity and even mortality has been reported to be associated with severe hyperphosphatemia and hypocalcemia [3][4][5][6].We report the case of a 13-year-old boy with Costello syndrome and chronic constipation who needed pediatric intensive care treatment after being administered four osmotically acting hypertonic phosphate enemas. With early intervention and treatment the boy survived without sequelae.…”

“…The accepted opinion is that the phosphate in these enemas is poorly absorbed; however, our clinical experience suggests otherwise. Significant morbidity and even mortality has been reported to be associated with severe hyperphosphatemia and hypocalcemia [3][4][5][6].…”