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The Risks of Phosphate Enemas in Toddlers: A Life-Threatening Unawareness

Alessandro Zago1, Alessandro Agostino Occhipinti1, Matteo Bramuzzo2

  • 1Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy.

Children (Basel, Switzerland)
|March 28, 2024
PubMed

Insights

Pediatricians show limited awareness of phosphate-containing enema (PcE) risks, despite their frequent use for fecal impaction. Many do not follow recommended dosages, increasing potential for serious toxicity.

Area of Science:

  • Pediatric Emergency Medicine
  • Gastroenterology
  • Clinical Pharmacology

Background:

  • Oral laxatives are first-line for fecal impaction.
  • Enemas are common in pediatric emergency departments (PEDs) and family pediatrics (FPs).
  • Phosphate-containing enemas (PcEs) carry a risk of rare but lethal toxicity.

Purpose of the Study:

  • To investigate pediatricians' awareness of the risks associated with phosphate-containing enemas (PcEs).

Main Methods:

  • An online survey with a multiple-choice questionnaire was distributed to referents in 51 PEDs and 101 FPs.
  • Responses were compared against Italian Drug Agency (AIFA) recommendations and existing literature on PcE administration.

Main Results:

  • 23 PEDs (45%) and 63 FPs (62.3%) participated.
  • 95% of PEDs and 33% of FPs reported using PcEs for fecal impaction.
  • 54% of PEDs and 86% of FPs did not adhere to AIFA daily dose recommendations.

Conclusions:

  • Pediatricians exhibit limited awareness regarding the potential dangers of phosphate-containing enemas.
  • Current clinical practices may not align with safety guidelines for PcE use in children.
Abstract

Keywords:
constipationpediatric gastroenterologyphosphate-containing enemasside effects

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