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[Risk of phosphate enemas in the infant]
1Service de pédiatrie, centre hospitalier Notre-Dame et Reine Fabiola, Charleroi, Belgique.
Insights
Hypertonic sodium phosphate enemas can cause severe electrolyte imbalances and dehydration in children. Due to these risks, phosphate enemas should be used with extreme caution in young children, especially those with bowel issues.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
Background:
- Hypertonic sodium phosphate enemas are commonly used for constipation relief.
- These enemas pose a risk of severe electrolyte disturbances, including hyperphosphatemia, hypernatremia, and hypocalcemia, along with dehydration.
Observation:
- A 14-month-old child with repaired Hirschsprung's disease presented with apathy, diagnosed as intestinal sepsis.
- The child had recently received a pediatric phosphate enema prior to admission.
- The clinical presentation and electrolyte abnormalities were attributed to enema-induced intoxication.
Findings:
- Phosphate enemas can lead to life-threatening electrolyte disturbances in children.
- Children with pre-existing renal insufficiency or bowel dysfunction are particularly vulnerable.
Implications:
- Phosphate enemas are contraindicated in children under 2 years old.
- Extreme caution is advised for children aged 2–5 years, even those without underlying conditions.
- Alternative constipation management strategies should be considered for pediatric patients.
Background:
Hypertonic sodium phosphate enema (Fleet) are available for relief of constipation. They may be responsible for life-threatening electrolyte disturbances (hyperphosphatemia, hypernatremia, hypocalcemia) and severe dehydration.
Observation:
A 14-month-old child with a neonatal repaired Hirschsprung's disease was urgently admitted for apathy. The clinical diagnosis was sepsis from intestinal origin. A few hours before admission, the child had received a pediatric phosphate enema ("Fleet Enema"). The clinical symptoms and the observed electrolyte disturbances were the consequences of the intoxication by the enema.
Conclusion:
In children with renal insufficiency or bowel dysfunction, phosphate enemas are dangerous. Even in normal children, they should not be used under 2 years of age and only with extreme caution between 2 and 5 years.