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Phosphate enema poisoning in children
J C Craig1, E M Hodson, H C Martin
1Royal Alexandra Hospital for Children, Camperdown, NSW.
The Medical Journal of Australia
|March 21, 1994
Summary
Phosphate enemas can cause severe hypocalcaemia and dehydration in young children. These enemas should be avoided in children under two and used cautiously in those aged two to five, especially with existing bowel or kidney issues.
Area of Science:
- Pediatric Gastroenterology
- Clinical Toxicology
- Pediatric Nephrology
Background:
- Phosphate enemas are commonly used for fecal retention in children.
- Underlying conditions like anorectal malformation and renal hypodysplasia may increase risk.
- Toxicity data in young children is limited.
Observation:
- A 23-month-old child developed hypocalcaemic tetany, hyperphosphataemia, hypokalaemia, and dehydration after two phosphate enemas.
- The child had a history of repaired anorectal malformation and unilateral renal hypodysplasia.
- Symptoms manifested 10 hours post-administration.
Findings:
- Phosphate enema administration led to significant electrolyte disturbances and dehydration.
- Management included rehydration, electrolyte correction, calcium supplementation, and phosphate binders.
- The child recovered fully without neurological sequelae.
Implications:
- Phosphate enemas are associated with substantial morbidity in children under five.
- Avoidance is recommended for children under two years of age.
- Extreme caution is advised for children aged two to five, particularly those with renal or bowel dysfunction.