Severe hyperphosphatemia after administration of sodium-phosphate containing laxatives in children: case series and systematic review of literature

Abstract

Physicians should be alerted to the possibility of phosphate toxicity in children and adolescents treated with laxatives.

Tetania severa por uso de enemas fosfatados, reporte de caso

“…It is estimated that 1 out of 3 children with functional constipation present at least one episode of fecaloma throughout their life 2 . Fecal disimpactation can be performed with oral or enteral osmotic laxatives, osmotic enemas, lubricants and glycerin suppositories [3][4][5] .…”

“…Thus, they produce a great movement of fluids towards the intestinal lumen, developing a third space that allows the emptying of the sigmoid-rectal fecal contents. Dehydration secondary to the intraluminal hyperosmolar effect of the solution and hypocalcemia secondary to absorption of high phosphorus content [5][6][7] are the main adverse effects of errors in dosing, administration and elimination of the enema. From the pathophysiological point of view, it is important to note that phosphorus is generally absorbed in duodenum and jejunum, but colonic absorption is possible secondary to high concentrations in the rectum 8 .…”

“…These symptoms may occur suddenly between 30 min and 4 hours after administration of the enema [5][6][7] .…”

“…With adequate renal function, hyperhydration and diuresis (phosphorus removal is mainly renal) should be performed 5,6 . The use of phosphorus binders to promote digestive elimination, such as calcium carbonate or calcium acetate, can be performed enterally to reduce phosphorus reabsorption from the intestinal lumen 6 and calcium 7 should be provided in case of symptomatic hypocalcemia.…”

Hemodialysis for Near-Fatal Sodium Phosphate Toxicity in a Child Receiving Sodium Phosphate Enemas

“…Risk factors for toxicity include underlying gastrointestinal or renal abnormalities and young age. 1 The typical treatment for sodium phosphate toxicity is intravenous fluid resuscitation and diuresis to promote renal clearance of phosphate. In addition, the administration of enteral phosphate binding resins inhibits further gastrointestinal absorption of the agent.…”