ABSTRACT
Los enemas fosfatados son utilizados frecuentemente en el tratamiento de la constipación. Errores en la posología pueden producir complicaciones graves. Objetivo: Reportar un caso de toxicidad grave por enema fosfatado en un pre escolar sin factores de riesgo. Caso clínico: Paciente de 2 años con constipación funcional, evaluada en servicio de urgencia por dolor abdominal a quién se le diagnosticó un fecaloma impactado. Recibió 2 dosis de enema de fosfato, medio frasco de Fleet® adulto (Synthon, Chile) por vez, sin resolución de su fecaloma, decidiéndose hospitalización para proctoclisis. Posterior al ingreso presentó un cuadro clínico de tetania. Ingresó a la Unidad de Paciente Crítico donde se confirmó una hiperfosfemia e hipocalcemia secundaria. Se realizó corrección electrolítica progresiva, retiro de enema fosfatado residual del recto e hiperhidratación forzando diuresis. La tetania cedió 2 horas después del ingreso sin otras complicaciones. Se realizó proctoclisis y fue dada de alta a los 3 días. Conclusión: Los enemas fosfatados pueden presentar complicaciones graves en niños sin factores de riesgo. Errores en la posología son la causa más frecuente de toxicidad en este grupo, pero esta puede estar favorecida también por una administración y eliminación inadecuadas. Pediatras y personal de salud que atiende a niños deben conocer factores de riesgo, signos y síntomas de intoxicación por enemas fosfatados.
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.
Subject(s)
Humans , Female , Child, Preschool , Phosphates/adverse effects , Tetany/chemically induced , Constipation/therapy , Enema/adverse effects , Hyperphosphatemia/chemically induced , Phosphates/therapeutic use , Tetany/diagnosis , Hyperphosphatemia/diagnosisABSTRACT
To retrospectively evaluate the epidemic characteristics of children with hypocalcemic convulsion related to nutritional rickets in the province of Kars, Turkey. In this study, clinical and laboratory findings of 93 infants, aged between 1-24 months, who were diagnosed as hypocalcemic convulsive resulting from nutritional rickets between January 2000 and June 2005 in Kars Maternity and Child Hospital, were investigated. The data of the cases with hypocalcemic convulsive rickets were collected from the hospital archive file. The mean and median ages of the cases were 8.93 and 6 [1-24] months, and 66 [71%] were male. Most of the patients were admitted to hospital in February and March, whereas 46% were admitted in winter, 44% in spring, 8% in autumn, and 2% in summertime. Serum calcium levels of all cases were low [mean: 5.4 +/- 0.84 mg/dl] and serum alkaline phosphate levels were high [mean: 1286 +/- 528 IU/L], while serum phosphorus levels were low in 19 [20.4%], high in 8 [8.6%], and normal in 66 [71%] patients. While evaluating the causes of convulsion, hypocalcemic convulsion related to nutritional rickets should be considered among the causes as well as age, gender, and season of the year, and diagnosis, and treatment should be initiated without delay. In addition, serum phosphorus level should also be questioned in the diagnosis of nutritional rickets