Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing Fleet pediatric enema.

Abstract

BACKGROUND:

Toxicity secondary to rectally administered hypertonic phosphate solution in patients with normal renal function is rarely reported in the literature. We report a case of electrolyte disturbance and seizure secondary to the rectal administration of 2 Fleet pediatric enemas.

CASE REPORT:

A 4-year-old white female with spinal muscular atrophy and chronic constipation was brought to the emergency department with complaints of lethargy and difficulty breathing following the administration of 2 Fleet pediatric enemas. In the emergency department, physical examination was significant for a depressed level of consciousness and shallow respirations. A basic metabolic profile was significant for a calcium of 3.3 mg/dL, phosphate of 23 mg/dL, and sodium of 153 mEq/L. Arterial blood gases revealed a pH of 7.24, Pco2 of 38 mm Hg, Po2 of 220 mm Hg. Electrocardiogram revealed a prolonged QT interval of 340 milliseconds with a corrected QT interval of 498 milliseconds. Sixteen hours postexposure, she experienced a generalized seizure unresponsive to multiple doses of lorazepam and responsive only to 100 mg of intravenous calcium chloride. Two days after presentation, the patient experienced complete resolution of symptoms.

CONCLUSION:

Osmotically acting hypertonic phosphate enemas can result in severe toxicity if retained. This is true even in patients without predisposing risk factors.

• Authors: Jeanna M Marraffa, Alan Hui, Christine M Stork
• Journal: Pediatric emergency care (Pediatr Emerg Care) Vol. 20 Issue 7 Pg. 453-6 (Jul 2004) ISSN: 1535-1815 [Electronic] United States
• PMID: 15232246 (Publication Type: Case Reports, Journal Article)

Chemical References

• Hypertonic Solutions
• Phosphates
• Calcium Chloride

Topics

• Acidosis (chemically induced)
• Administration, Rectal
• Calcium Chloride (therapeutic use)
• Child, Preschool
• Consciousness Disorders (chemically induced)
• Constipation (etiology, therapy)
• Dyspnea (chemically induced)
• Enema (adverse effects)
• Epilepsy, Generalized (chemically induced)
• Female
• Humans
• Hypernatremia (chemically induced)
• Hypertonic Solutions (adverse effects)
• Hypocalcemia (chemically induced, drug therapy)
• Intestinal Absorption
• Muscular Atrophy, Spinal (complications)
• Phosphates (administration & dosage, adverse effects, blood, pharmacokinetics)