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Medline ® Abstracts for References 45-48

of 'Chronic functional constipation and fecal incontinence in infants and children: Treatment'

45
TI
Hypocalcemia and hyperphosphatemia after phosphate enema use in a child.
AU
Helikson MA, Parham WA, Tobias JD
SO
J Pediatr Surg. 1997;32(8):1244.
 
The authors present a 3-year-old girl in whom severe hyperphosphatemia and hypocalcemia developed after the administration of three adult-sized hypertonic phosphate enemas. The commonly held notion that these enemas are not absorbed and therefore are systemically inactive is incorrect. With early intervention and treatment, the child survived without sequelae despite a serum phosphate level (74.7 mg/dL) that is greater than those previously reported. The treatment of hyperphosphatemia is reviewed as well as underlying pathology such as altered gastrointestinal motility and renal insufficiency, which may predispose the patient to this problem. Physicians should be aware of the possible adverse effects that can be caused by hypertonic phosphate enemas.
AD
Department of Surgery, School of Medicine, The University of Missouri, Columbia 65212, USA.
PMID
46
TI
Enema-induced severe hyperphosphatemia in children.
AU
Biebl A, Grillenberger A, Schmitt K
SO
Eur J Pediatr. 2009;168(1):111.
 
We report the case of a 13-year-old boy with Costello syndrome and chronic constipation who received phosphate-containing Fleet-pediatric enemas at regular intervals. The day before admission he was given four enemas for severe constipation. Within 24 h the boy had developed severe hyperphosphatemia (phosphate 17.75 mmol/L), hypertonic dehydration (sodium 171 mmol/L) and severe hypocalcemia (calcium 0.56 mmol/L). With early intervention and treatment, the child survived without sequelae. Osmotically acting hypertonic phosphate enemas may result in severe toxicity. Children with developmental delay often display bowel dysfunction and chronic constipation and are therefore high-risk patients. The accepted opinion-that these enemas are not absorbed and therefore systemically inactive-is not true. Physicians should be aware of the potentially lethal complications of this treatment, which is part of everyday clinical practice.
AD
Department of Pediatrics, Children's Hospital, Linz, Austria. ariane.biebl@gespag.at
PMID
47
TI
Systematic review: the adverse effects of sodium phosphate enema.
AU
Mendoza J, Legido J, Rubio S, Gisbert JP
SO
Aliment Pharmacol Ther. 2007;26(1):9.
 
BACKGROUND: Sodium-phosphate enemas are widely used to treat constipation, and are rarely associated with side effects.
AIM: A systematic review of the literature was conducted to identify the most common adverse effects of sodium-phosphate enemas and associated risk factors.
METHODS: A systematic search was conducted in Internet (MEDLINE), and the Cochrane Library, from January 1957 to March 2007.
RESULTS: A total of 761 references were identified initially, and 39 relevant papers were finally selected. The most common therapeutic indications included constipation (63%). Sixty-eight per cent of the patients having adverse effects had associated conditions, the most common being gastrointestinal motility disorders, cardiological diseases and renal failure. Virtually, all side effects were due to water and electrolyte disturbances. Most patients were under 18 years of age (66%) or older than 65 years (25%). A total of 12 deaths were found.
CONCLUSION: The main side effects caused by sodium phosphate enemas are water and electrolyte disturbances. The main risk factors are extreme age and associated comorbidity.
AD
Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.
PMID
48
TI
A fatal small dose of phosphate enema in a young child with no renal or gastrointestinal abnormality.
AU
Ismail EA, Al-Mutairi G, Al-Anzy H
SO
J Pediatr Gastroenterol Nutr. 2000;30(2):220.
 
AD
Department of Paediatrics, Farwanyia Hospital, Kuwait.
PMID