Abstract:
Background: Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage
and administration can lead to severe complications. Objective: To report a case of severe toxicity
of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation,
was brought to emergency department because abdominal pain. She was diagnosed with
fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times,
with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission,
she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe
hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte
correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2
hours after admission and no other complications. Proctoclisis was performed and patient was discharged
three days after admission with pharmacological management of constipation. Conclusion:
Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage,
administration and removal of the enema are causes of toxicity in this group. Pediatricians and health
personnel must be aware of risks and signs of toxicity of phosphate enema.
