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Phosphate enemas causing profound refractory hypocalcaemia: A case report.
Jennifer Nobes1, Michael J Murphy1
1Biochemical Medicine, Ninewells Hospital, Dundee, UK.
Phosphate enemas, used to treat hepatic encephalopathy in a patient with alcohol-related liver disease, caused severe hypocalcemia due to rectal phosphate absorption. Stopping the enemas corrected the electrolyte imbalance.
Area of Science:
- Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Alcohol-related liver disease (ALD) can lead to decompensated cirrhosis and hepatic encephalopathy.
- Hepatic encephalopathy management often involves reducing nitrogenous waste, including the use of enemas.
- Electrolyte disturbances are common complications in patients with advanced liver disease.
Purpose of the Study:
- To report a rare case of severe hypocalcemia and hyperphosphatemia.
- To identify the cause of the electrolyte imbalance in a patient with decompensated cirrhosis.
- To highlight a potential adverse effect of phosphate enemas in liver disease patients.
Main Methods:
- A case report of a 37-year-old woman with alcohol-related liver disease and hepatic encephalopathy.
- Monitoring of serum calcium and phosphate levels during treatment with phosphate enemas.
- Clinical assessment and discontinuation of phosphate enemas based on laboratory findings.
Main Results:
- The patient developed severe hypocalcemia (nadir 0.85 mmol/L) and hyperphosphatemia (6.4 mmol/L) after initiation of phosphate enemas.
- Discontinuation of phosphate enemas led to normalization of serum phosphate within 72 hours.
- Significant intravenous calcium supplementation was required to correct the hypocalcemia.
Conclusions:
- Rectal absorption of phosphate from enemas can cause severe hypocalcemia in patients with decompensated cirrhosis.
- Phosphate enemas should be used with caution in patients with liver disease due to the risk of electrolyte disturbances.
- This case underscores the importance of vigilant electrolyte monitoring in patients receiving enema therapy.
