Iatrogenic neonatal hyperphosphatemia due to phosphate-containing enema

Area of Science:

• Pediatric Gastroenterology
• Neonatal Intensive Care
• Clinical Toxicology

Background:

• Functional constipation is prevalent in infants.
• Phosphate-containing enemas (PCEs) are contraindicated in neonates due to risks of severe electrolyte disturbances.
• Infants may present with irritability and ECG anomalies as sole indicators of acute hyperphosphatemia post-PCE administration.

Purpose of the Study:

• To report a case of severe electrolyte disturbance in a neonate following PCE administration.
• To emphasize the risks of inappropriate PCE use in neonates.
• To highlight the importance of prompt recognition and management of complications.

Main Methods:

• Case report of a 28-day-old neonate with constipation and vomiting after PCE administration.
• Monitoring for electrolyte levels (hyperphosphatemia, hypocalcemia) and ECG changes (prolonged QTc).
• Treatment with hyperhydration, intravenous calcium gluconate, and oral alfacalcidol.

Main Results:

• The neonate developed severe hyperphosphatemia, hypocalcemia, and a prolonged QTc interval.
• Clinical recovery was achieved within 60 hours following supportive therapy.
• No underlying health conditions were noted in the patient.

Conclusions:

• Inappropriate use of over-the-counter PCEs in neonates carries significant risks, even without comorbidities.
• Early recognition of symptoms like irritability and ECG changes is vital.
• Effective supportive care is essential for managing life-threatening complications from electrolyte imbalances.