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[Phosphate Intoxication after Application of Enema--a Life-threatening Iatrogenic Complication]

I Marek, K Benz, S Kusnik

    Klinische Padiatrie
    |June 4, 2015
    PubMed

    Insights

    Phosphate enemas can cause life-threatening hyperphosphatemia in infants, especially with underlying conditions. Safer alternatives like glycerol or sorbitol enemas are recommended for pediatric constipation.

    Area of Science:

    • Pediatric Gastroenterology
    • Toxicology
    • Nephrology

    Background:

    • Phosphate-containing enemas are used for pediatric constipation.
    • Risk of severe hyperphosphatemia, hypocalcemia, and acidosis exists with prolonged retention or impaired renal function.

    Observation:

    • A 6-month-old infant developed severe hyperphosphatemia (19.87 mmol/l) after receiving an unlicensed phosphate enema.
    • The infant's condition mimicked sepsis and required hemodialysis.
    • Undiagnosed Hirschsprung disease contributed to enema retention, ileus, and toxic megacolon, necessitating surgery.

    Findings:

    • Phosphate enema intoxication can be life-threatening in infants.
    • Hemodialysis is an effective treatment for severe hyperphosphatemia.
    • Gastrointestinal or renal comorbidities increase the risk of phosphate enema toxicity.

    Implications:

    • Physicians should avoid phosphate enemas in infants, particularly those with GI or renal issues.
    • Safer enema alternatives, such as glycerol or sorbitol, are recommended for pediatric constipation.
    • Early diagnosis and management of underlying conditions like Hirschsprung disease are crucial.
    Abstract

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