Hyperphosphatemic Hypocalcemic Coma Caused by Hypertonic Sodium Phosphate (Fleet) Enema Intoxication

Knobel, B; Petchenko, Paulina

doi:10.1097/00004836-199610000-00013

Cited by 23 publications

(19 citation statements)

References 10 publications

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“…Intravascular contraction which results from the fluid loss leads to secondary hyperaldosteronism and enhances renal potassium loss [14]. Metabolic acidosis may be caused by a variety of mechanisms: bicarbonate loss through the gut, poisoning of the phosphate‐dependent portion of cellular mechanism [15], and the presence of excess phosphate in the form of inorganic acid.…”

Section: Discussionmentioning

confidence: 99%

Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation

et al. 2002

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Summary Sodium phosphate is widely used as an effective bowel preparation agent. It is used in smaller volumes, leading to improved patient tolerance. Although it is generally safe, cases of severe hyperphosphataemia following sodium phosphate administration have been reported in the literature. The common risk factors identified are advanced age, impaired renal function, impaired colonic motility and multiple doses. However, many doctors remain unaware of the dangers associated with this agent. We report six cases of severe electrolyte and metabolic derangement due to sodium phosphate bowel preparation: two patients had delayed awakening from general anaesthesia, and four patients suffered life‐threatening consequences.

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Section: Discussionmentioning

confidence: 99%

Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation

et al. 2002

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“…6 Oral sodium phosphate-and sodium picosulfatecontaining purgatives are potent medications and have been associated with numerous side effects, most notably electrolyte abnormalities including symptomatic hypocalcemia, hyperphosphatemia, hypernatremia, hypokalemia, metabolic acidosis, hypomagnesemia, and hyperglycemia. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other reported adverse effects include bloating, cramps, abdominal pain, nausea, confusion, coma, respiratory and circulatory failure, acute renal failure, pancytopenia, and death. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Oral sodium phosphate-and sodium picosulfate/ magnesium citrate-containing purgatives are not recommended in patients with cardiopulmonary disease, renal or hepatic disease, or bowel obstruction.…”

Section: Case Reportsmentioning

confidence: 99%

“…29,30 Oral sodium phosphate-containing and sodium picosulfate/ magnesium citrate solution-containing purgatives can cause dehydration and hypovolemia, with resulting hyponatremia, through induction of an osmotic cathartic action. 20,21 The induction of hyponatremia is uncommon but thought to occur through excess oral rehydration. [30][31][32][33][34] This may have been potentiated by the long-term use of diuretics in two of our patients.…”

Section: Case Reportsmentioning

confidence: 99%

Hyponatremia and Seizures After Bowel Preparation: Report of Three Cases

Frizelle

Colls

2005

Diseases of the Colon &Amp; Rectum

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Oral sodium phosphate and sodium picosulfates/magnesium citrate are commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. These substances, however, are known to cause electrolyte abnormalities. Seizures caused by electrolyte abnormalities associated with bowel preparation have only rarely been reported. We report the cases of three patients with no prior history of seizures, who had their first seizure associated with hyponatremia following ingestion of sodium phosphate or sodium picosulfates/magnesium citrate combination. Care must be taken with patients with a low seizure threshold and those with possible chronic sodium depletion, such as patients on thiazide diuretics, who are undertaking bowel preparation with oral sodium phosphate or sodium picosulfates/magnesium citrate combination.

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“…Phosphate poisoning has been reported previously in association with sodium phosphate enemas, occurring after the administration of an adult sized enema to a child or after repeated administration to an elderly patient [1, 2]. Our case draws attention to the possibility of phosphate poisoning by the oral route, due to the deliberate ingestion of domestic cleaning liquids.…”

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confidence: 64%

Phosphate poisoning by ingestion of clothes washing liquid and fabric conditioner

Vincent

Sheikh

1998

Anaesthesia

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SummaryA case is reported in which suspicion of malignant vasovagal syndrome was aroused by a history of faints and needle phobia. The vasovagal response was successfully avoided using a gaseous induction of anaesthesia with sevoflurane. Intravenous access was achieved under general anaesthesia. The diagnosis of malignant vasovagal syndrome was confirmed postoperatively using a head-up tilt table test. An outline of the pathophysiology of the syndrome gives some indication for suitable anaesthetic management strategies in similar cases. A vasovagal response [1] -the inappropriate combination of vasodilatation and bradycardia resulting in cardiovascular collapse, syncope and perhaps asystolic cardiac arrestmay be associated with either a relative or an actual loss of blood or episodes of emotional stress, excitement or pain. These neurally mediated reflexes are expected in the peri-operative period and may occur in a variety of situations [2][3][4][5]. In patients in whom the vasovagal response proceeds to asystole, the term 'malignant vasovagal' or 'malignant bradycardia/hypotension' syndrome [6] is used, thereby emphasising the potentially fatal outcome.We describe the anaesthetic management of a patient with malignant vasovagal syndrome and discuss the pathophysiology of the condition and therapeutic options for its management. Case historyA 23-year-old, 52-kg female patient suffering from pain secondary to chondromalacia patellae had been scheduled for left knee arthroscopy as a day case. Pre-operative history revealed that, as a child, she had experienced several blackouts associated with one or two episodes of seizures. The blackouts, which only occurred when blood was being taken or when she was in pain, had been assumed by the patient to be the consequence of a simple needle phobia, since investigations had not established a cause for these episodes. Coincidentally, she had 'fainted' prior to induction of anaesthesia for dental operations 3 and 4 years previously and the cause for these faints had automatically been attributed to the needle phobia.From further questioning and review of the medical notes it became apparent that during venepuncture for the most recent anaesthetic, she had suffered a sudden asystolic arrest lasting 3 min and treated by external cardiac massage, atropine and oxygen with assisted ventilation. The operation proceeded without further complication. The remainder of the anaesthetic history did not reveal any further problems and vital signs, chest examination and ECG were normal. A presumptive diagnosis of malignant vasovagal syndrome was made.The outcome of the subsequent discussion with the patient was a decision to proceed with the surgery by inducing anaesthesia with sevoflurane prior to establishing venous access, and it was agreed that overnight observation in hospital was advisable. The patient was premedicated with oral temazepam, 10 mg, and arrived in the anaesthetic room in a tranquil state. Inspired oxygen analysis, ECG, noninvasive blood pressure and pulse oximetry 10...

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Hyperphosphatemic Hypocalcemic Coma Caused by Hypertonic Sodium Phosphate (Fleet) Enema Intoxication

Cited by 23 publications

References 10 publications

Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation

Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation

Hyponatremia and Seizures After Bowel Preparation: Report of Three Cases

Phosphate poisoning by ingestion of clothes washing liquid and fabric conditioner

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