Hypocalcemia and hyperphosphatemia after phosphate enema use in a child

Area of Science:

• Pediatric Nephrology
• Clinical Toxicology
• Gastroenterology

Background:

• Hypertonic phosphate enemas are commonly believed to be systemically inactive due to minimal absorption.
• This case challenges the assumption of safety, highlighting potential systemic toxicity.

Observation:

• A 3-year-old girl developed severe hyperphosphatemia and hypocalcemia following three adult-sized hypertonic phosphate enemas.
• Her serum phosphate level reached 74.7 mg/dL, a level exceeding previously reported cases.

Findings:

• The patient survived without sequelae due to early intervention and treatment.
• The study underscores that phosphate enemas can be significantly absorbed and cause systemic effects.

Implications:

• Physicians must recognize the potential adverse effects of hypertonic phosphate enemas, particularly in pediatric patients.
• Underlying conditions like altered gastrointestinal motility or renal insufficiency may increase susceptibility to phosphate toxicity.
• This case necessitates a re-evaluation of the safety profile and administration guidelines for phosphate enemas.