Iatrogenic neonatal hyperphosphatemia due to phosphate-containing enema
Elise Nauwynck1,2, Jesse Vanbesien1,2, Willem Staels1,3
1Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
Insights
Phosphate-containing enemas (PCEs) pose severe risks for neonates, causing dangerous electrolyte imbalances like hyperphosphatemia and hypocalcemia. Prompt medical intervention is crucial for recovery, highlighting the need to avoid PCEs in this age group.
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.
Summary:
Functional constipation is a common condition in infants. Phosphate-containing enemas (PCEs) are contraindicated in neonates due to the significant risk of severe electrolyte disturbances. We report a case of a 28-day-old neonate presenting with constipation and vomiting following the administration of PCEs. This resulted in hyperphosphatemia, hypocalcemia, and a prolonged QTc interval - critical conditions requiring urgent intervention. Management included hyperhydration, intravenous calcium gluconate, and oral alfacalcidol, which led to complete clinical recovery within 60 h. This case underscores the serious risks associated with inappropriate use of over-the-counter PCEs in neonates, even in the absence of underlying health conditions. It also highlights the importance of early recognition and effective supportive therapy to mitigate potential life-threatening complications.
Learning Points:
Irritability and ECG anomalies can be the only signs and symptoms of severe acute hyperphosphatemia after administration of PCE. Clinicians should be aware of the risk of severe acute hyperphosphatemia after PCE administration in infants, even without comorbidities, due to a low PTH status. When symptomatic hypocalcemia occurs, intravenous calcium administration is warranted, as the risk of life-threatening consequences from hypocalcemia significantly outweighs the risk of developing metastatic calcifications.
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