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Fatal complication caused by laxative suppository agent on pediatric patient with hydrocephalus on
Akmal Niam Firdausi Masyhudi1, Muhammad Arifin Parenrengi1, Wihasto Suryaningtyas2
1Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Insights
Laxative suppositories can cause fatal complications in children with hydrocephalus and VP shunts due to increased abdominal pressure. Oral laxatives are safer for these patients.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Neurology
Background:
- Constipation is common in pediatric patients, often treated with laxatives.
- Hydrocephalus and ventriculo-peritoneal (VP) shunts are pre-existing conditions that can affect patient susceptibility.
- Laxative suppositories offer rapid relief but carry potential risks.
Observation:
- A case report details an 11-year-old boy with hydrocephalus and a VP shunt who received a laxative suppository for constipation.
- The patient experienced rapid deterioration, including abdominal pain, cardiac arrest, and death within hours of administration.
- Autopsy findings were not detailed, but the clinical course suggests a link to the medication.
Findings:
- The fatal complication is hypothesized to stem from elevated intra-abdominal pressure leading to abdominal compartment syndrome (ACS).
- ACS can cause multi-organ dysfunction, including impaired central nervous system function due to increased intracranial pressure (ICP).
- Pediatric patients with VP shunts have reduced brain compliance, making them vulnerable to acute ICP elevations.
Implications:
- Laxative suppositories pose a significant risk for pediatric patients with hydrocephalus and VP shunts.
- Oral laxatives are recommended for constipated patients with pre-existing neurological conditions.
- Close monitoring is crucial if laxative suppositories are administered to high-risk pediatric patients.
Introduction:
Laxative suppository agent is oftenly used for patient with constipation due to its effectiveness and rapid onset. However, beside the benefit of the drugs, it could cause several side effects which could lead to life-threatening complication. In this report, we present a rare case of laxative's side effect that leads to fatal complication in pediatric patient with history of hydrocephalus and ventriculo-peritoneal (VP) shunt placement.
Case Report:
An 11 years old boy admitted with general weakness, low nutrition intake, and constipation for 4 days. Patient had a history of VP shunt surgery at half months old due to congenital hydrocephalus. Abdominal X-ray found colon dilatation and fecal material collection. Laxative suppository agent was given to the patient. An hour after the treatment, patient had an abdominal pain followed by defecation, and 30 min after defecation, patient was unresponsive with irregular breathing followed by cardiac arrest. Code blue was activated and resuscitation was done for about 40 min, and patient did not respond to resuscitation and pronounced dead 2.5 h after drug's administration.
Discussion:
The pathophysiology of this complication is related with elevated intraabdominal pressure that caused abdominal compartment syndrome (ACS), and this condition could lead to several organ dysfunction such as cardiopulmonary and abdominal organ dysfunction inducing central nervous system impairment through raised intracranial pressure (ICP). Pediatric patient with history of hydrocephalus on VP shunt could have a low brain compliance and very susceptible to fatal complication due to acute raised of ICP.
Conclusion:
Laxative suppository agent on pediatric patient with hydrocephalus on VP shunt could lead to fatal complication through ACS and acute elevated ICP pressure. Oral laxative agent should be chosen in constipated patient with neurologic preexisting condition, and patient should be closely monitored if suppository agent is given.
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