Tetania severa por uso de enemas fosfatados, reporte de caso

Abstract

Background: Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. Objective: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. Conclusion: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.

Severe hyperphosphataemia and metabolic acidosis after administration of phosphate-containing enema in a 10-year-old girl – case report and review of literature

“…Those at higher risk include patients with cardiac disease and reduced glomerular filtration rate (chronic or acute kidney diseases) [14]. A literature review showed that complications after enemas are also more common in children with gastroenterological conditions; for example, Hirschsprung's disease [17]. Yet, most of the reported severe adverse events were because of overdose, simultaneous admission of oral and rectal laxatives, or other contraindications [18].…”

“…Núñez Sánchez reported a case of a generally healthy girl aged 2 years and 7 months, who had been given sodium-phosphate enema twice due to constipation. After 2 hours she presented painful hypertonia of the upper and lower extremities, and her laboratory tests showed hyperphosphataemia, hypocalcaemia, and metabolic acidosis [17].…”

Spectrum of Disorders associated with Tetany

“…6 Phosphate enema causes tetany due to hyperphosphatemia and subsequent development of hypocalcemia from metastatic calcium phosphate deposits. 63 Anecdotal case reports of tetany are seen with hyperemesis gravidarum, short bowel syndrome, Crohn's disease, and falciparum malaria. [64][65][66][67] Dengue fever may aggravate hypocalcemia of primary hypoparathyroidism and can present with tetany 5 .…”