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Morbid hypocalcemia associated with phosphate enema in a six-week-old infant
D M Walton1, D C Thomas, H Z Aly
1Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA. haly@cnmc.org
Insights
A premature infant experienced seizures and bradycardia after receiving a Fleet enema for constipation. This case highlights the dangers of improper enema use in infants, emphasizing the need for parental education.
Area of Science:
- Neonatology
- Pediatric Emergency Medicine
- Clinical Toxicology
Background:
- Premature infants are vulnerable to electrolyte imbalances.
- Constipation is a common concern for new parents.
- Improper administration of over-the-counter treatments can lead to severe complications.
Observation:
- A 6-week-old premature infant (29 weeks gestation) presented with seizures, apnea, and bradycardia.
- Initial labs revealed severe hypocalcemia (2.4 mg/dL) and hyperphosphatemia (28.5 mg/dL).
- The infant's mother reported administering a pediatric Fleet enema prior to symptom onset.
Findings:
- Fleet enema administration in a premature infant led to severe electrolyte disturbances.
- The infant required intubation and cardiopulmonary resuscitation.
- The patient recovered after stabilization and treatment for hypocalcemia and hyperphosphatemia.
Implications:
- This case underscores the critical need for comprehensive parental education regarding infant constipation management.
- Healthcare providers should emphasize the risks associated with inappropriate enema use in neonates.
- Early well-child visits are crucial for addressing parental concerns and preventing hazardous home treatments.
Abstract:
A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.