The Pharmacological Effect of Sodium Phosphate After Absorption from the Peritoneal Cavity

Abstract

Hyperosmolar solutions are frequently used in clinical practice for enemas. In a review of the literature we found 43 published cases of severe complications connected with the use of hyperosmolar enemas. The absorption of sodium phosphate led to a raise of the temperature up to 41.1 degrees C, massive acidosis and electrolyte disturbances with hypocalcemia and hypernatremia. The clinical picture was dominated in most of the cases by somnolence or coma. In our experiment the absorption of sodium phosphate from the peritoneal cavity of rats led to similar clinical symptoms and--depending on the amount of sodium phosphate absorbed--to the death of the animals. Hypovolemia, hypernatremia, hypocalcemia and a direct toxic effect of phosphate on the kidneys is responsible for the complex mode of intoxication. Sodium phosphate solutions should not be used in patients with inflammatory bowel disease with a high risk of laceration of the mucosa or perforation of the bowel.

Respiratory failure requiring extracorporeal membrane oxygenation after sodium phosphate enema intoxication

“…The hyperosmolarity of these solutions draws fluid into the intestinal lumen to stimulate peristalsis. A number of cases of significant toxicity secondary to use of these solutions have been reported [1,2,3,4,5,6,7,8,9,10,11,12,13,15,16,17,18,19,20,21,22,23,24,25,29,30,31,32,33,34,35,36,37].…”

“…High-dose sodium phosphate has been shown to cause necrosis of the renal tubular epithelium in rats [21]. Gastrointestinal complications of HSPE and HSPL toxicity include paralytic ileus with prolonged retention of the solution.…”

“…Patients may also hypoventilate secondary to central nervous system depression. Cyanosis and pulmonary edema have been reported [21,22,25]. The etiology of pulmonary toxicity is not entirely understood but may involve ectopic pulmonary calcification and phosphate-mediated lung injury [22,26,38].…”

“…We propose that our patient's rapid deterioration was associated with phosphate toxicity. Impaired oxygen diffusion is a known complication of hyperphosphatemia in animals and humans [21,26].…”

Forensic application of ESEM and XRF-EDS techniques to a fatal case of sodium phosphate enema intoxication

“…Lochbühler et al noticed that after intraperitoneal infusion of 3-4 g/kg body weight of SP, more than 80% of the rats died of severe acidosis with hypernatremia (>160 mmol/l), hypocalcemia, and hyperphosphatemia [9]. We are unaware of other reports on human intoxication due to the peritoneal absorption of SP solutions, except for the paper of Lochbühler et al [9].…”