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Hypocalcemic coma following two pediatric phosphate enemas
Insights
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.
Abstract:
Coma, tetany, dehydration, hypotension, tachycardia, and hyperpyrexia developed in a 2 1/2-year-old girl following two hypertonic phosphate pediatric enemas. She had marked hyperphosphatemia, hypocalcemia, hypernatremia, and acidosis. Hypocalcemia due to hyperphosphatemia can explain all of these findings. Calculations indicate that about one third of the phosphorus and sodium contents of the enema were absorbed. Physicians should be aware of the potentially lethal complication of this treatment, which is part of everyday practice.