Severe hyperphosphatemia and hypocalcemic tetany after oral laxative administration in a 3-month-old infant

Area of Science:

• Pediatric Emergency Medicine
• Clinical Toxicology
• Gastroenterology

Background:

• Phosphate-containing enemas are known to pose risks, but oral formulations are less commonly associated with toxicity.
• Infants are particularly vulnerable to electrolyte imbalances due to their immature organ systems and lower body weight.

Observation:

• A 3-month-old infant presented with respiratory distress and tetany following ingestion of a phosphate-containing oral laxative.
• Initial serum phosphorus levels were critically elevated at 38.3 mg/dL, indicating severe hyperphosphatemia.

Findings:

• The infant experienced hypocalcemic tetany secondary to severe hyperphosphatemia.
• Aggressive fluid resuscitation and intravenous calcium administration were crucial in managing the acute toxicity.
• Complete recovery was achieved with prompt medical intervention.

Implications:

• Over-the-counter phosphate laxatives can cause life-threatening hyperphosphatemia and hypocalcemic tetany in infants.
• Physicians must be vigilant for phosphate toxicity in young children using these products.
• Caregivers should be strongly advised against administering OTC laxatives to infants without medical guidance to prevent severe adverse events.