Hypocalcemia, hyperphosphatemia, and dehydration following a single hypertonic phosphate enema

Area of Science:

• Nephrology
• Endocrinology
• Gastroenterology

Background:

• Phosphate enemas are typically considered safe when used as directed.
• Previous reports of adverse effects were linked to renal disease or overuse.
• The risk of systemic phosphate absorption was not fully appreciated in healthy individuals.

Observation:

• Two patients developed severe hypocalcemia and hyperphosphatemia after a single phosphate enema.
• Moderate dehydration in these patients impaired renal excretion of absorbed phosphate.
• Symptomatic hypocalcemia and hyperphosphatemia occurred rapidly.

Findings:

• Systemic absorption of phosphate from a single enema can cause significant electrolyte disturbances.
• Dehydration exacerbates phosphate retention and prolongs hypocalcemia.
• Renal function is crucial for clearing absorbed phosphate.

Implications:

• Phosphate enemas should be used with caution, even in patients without renal disease.
• Adequate hydration is essential during and after phosphate enema administration.
• Monitoring of serum calcium and phosphate levels may be warranted in at-risk patients.