Enema-induced severe hyperphosphatemia in children.

Area of Science:

• Pediatric Gastroenterology
• Clinical Toxicology

Background:

• Phosphate-containing enemas are commonly used for pediatric constipation.
• Children with developmental delay often experience chronic constipation and bowel dysfunction.

Observation:

• A 13-year-old boy with Costello syndrome and chronic constipation received multiple phosphate enemas.
• Within 24 hours, he developed severe hyperphosphatemia, hypertonic dehydration, and hypocalcemia.

Findings:

• Phosphate enemas can be systemically absorbed, leading to severe toxicity.
• This case demonstrates potentially lethal complications of phosphate enema use.

Implications:

• Physicians must recognize the risks associated with phosphate enemas, especially in high-risk pediatric patients.
• The assumption of systemic inactivity of these enemas is incorrect and dangerous.