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Hyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (fleet) enema intoxication
1Department of Medicine B, Edith Wolfson Medical Center, Holon, Israel.
Journal of Clinical Gastroenterology
|October 1, 1996
Summary
Phosphate enema overdose caused severe electrolyte imbalances and organ failure in an elderly woman. Safer alternatives or cautious use in renal failure patients are recommended to prevent phosphate intoxication.
Area of Science:
- Nephrology
- Toxicology
- Internal Medicine
Background:
- Hypertonic sodium phosphate enemas are used for bowel preparation.
- Enemas can lead to significant systemic absorption, especially in compromised patients.
Observation:
- An elderly woman presented with hyperphosphatemic hypocalcemic coma, hypernatremia, hypokalemia, metabolic acidosis, pancytopenia, and cardiorespiratory failure.
- These severe complications were secondary to phosphate intoxication from an overdose of a hypertonic sodium phosphate enema.
Findings:
- The case highlights the potential for severe toxicity from sodium phosphate enemas.
- Factors contributing to increased absorption and decreased excretion of phosphate were discussed.
Implications:
- This case underscores the risks associated with sodium phosphate enemas, particularly in patients with renal impairment.
- Safer cathartic medications or extremely cautious enema use in at-risk populations are advised to prevent severe phosphate intoxication.