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Hypocalcemic coma following two pediatric phosphate enemas
Pediatrics
|September 1, 1977
Summary
Pediatric hypertonic phosphate enemas can cause severe, life-threatening complications like coma and tetany due to electrolyte imbalances. This case highlights the critical need for awareness of these risks in routine medical practice.
Area of Science:
- Pediatric Gastroenterology
- Clinical Toxicology
Background:
- Hypertonic phosphate enemas are commonly used in pediatric practice for constipation.
- Potential risks associated with enema administration are not always fully appreciated.
Observation:
- A 2 1/2-year-old girl developed severe systemic toxicity after receiving two hypertonic phosphate enemas.
- Clinical manifestations included coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia.
Findings:
- Laboratory analysis revealed marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis.
- The observed clinical symptoms are consistent with severe electrolyte disturbances, particularly hypocalcemia secondary to hyperphosphatemia.
- Calculations suggest significant absorption of both phosphorus and sodium from the enema solution.
Implications:
- This case underscores the potentially lethal complications of hypertonic phosphate enemas in children.
- Healthcare providers must exercise caution and be aware of the risks associated with this seemingly routine procedure.
- Alternative, safer methods for managing constipation in pediatric patients should be considered.