Abstract
Fleet enemas are hypertonic solutions with an osmotic action and a high concentration of phosphate. When retained in the human body they have a great toxic potential, causing severe hydro-electrolyte disorders in children, especially in newborns. We report the case of a previously healthy 8-day-old newborn who needed neonatal intensive care treatment after the inadvertent administration of an osmotically active hypertonic phosphate enema. Taking into account that phosphate removal by peritoneal dialysis (PD) strongly depends on total dialysate turnover, we chose continuous flow PD (CFPD) as the treatment option, with a successful outcome. Clinical experience with this dialytic modality is limited to a few case reports in pediatric and adult patients. To the best of our knowledge, we report here the first description of CFPD in the setting of acute phosphate nephropathy in the neonatal period. The modality of PD described here has potential as an alternative management option as it is a highly efficient, methodologically simple, and low-cost method without any need for sophisticated equipment. Physicians and parents should be aware of the adverse effects of a hypertonic phosphate enema and should never use these medications in infants and newborns.
References
Marraffa JM, Hui A, Stork CM (2004) Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing Fleet pediatric enema. Pediatr Emerg Care 20:453–456
Biebl A, Grillenberger A, Schmitt K (2009) Enema-induced severe hyperphosphatemia in children. Eur J Pediatr 168:111–112
Hyams JS, Treem WR, Etienne NL, Weinerman H, MacGilpin D, Hine P, Choy K, Burke G (1995) Effect of infant formula on stool characteristics of young infants. Pediatrics 95:50–54
Loening-Baucke V (1993) Chronic constipation in children. Gastroenterology 105:1557–1564
Sievers E, Oldigs HD, Schulz-Lell G, Schaub J (1993) Faecal excretion in infants. Eur J Peditr 152:452–454
Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2006) Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 43:e1–13
Martin RR, Lisehora GR, Braxton M Jr, Barcia PJ (1987) Fatal poisoning from sodium phosphate enema. Case report and experimental study. JAMA 257:2190–2192
Hsu HJ, Wu MS (2008) Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Intern Med 47:643–646
Steinman T, Samir A, Cornell L (2008) A 64-year-old man with abdominal pain, nausea, and an elevated level of serum creatinine. N Engl J Med 359:951–960
Fischbach M (1996) Peritoneal dialysis prescription for neonates. Perit Dial Int 16[Suppl 1]:S512–S514
Schmitt C, Borzych D, Nau B (2009) Dialytic phosphate removal: A modifiable measure of dialysis efficacy in automated peritoneal dialysis. Perit Dial Int 29:465–471
Kuhlmann M (2010) Phosphate elimination in modalities of hemodialysis and peritoneal dialysis. Blood Purif 29:137–144
Diaz B (2002) Continuous flow peritoneal dialysis: clinical applications. Blood Purif 20:36–93
Amerling R, DeSimon L, Inciong-Reyes R (2001) Clinical experience with continuous flow and flow-through peritoneal dialysis. Semin Dial 14:388–390
Amerling R, Glezerman I, Savransky E (2003) Continuous flow peritoneal dialysis: principles and applications. Semin Dial 16:335–340
Arbeiter AK, Kranz B, Wingen AM (2010) Continuous venovenous haemodialysis (CVVHD) and continuous peritoneal dialysis (CPD) in the acute management of 21 children with inborn errors of metabolism. Nephrol Dial Transplant 25:1257–1265
Sagy M, Silver P (1999) Continuous flow peritoneal dialysis as a method to treat severe anasarca in children with acute respiratory distress syndrome. Crit Care Med 27:2532–2536
Dissaneewate S, Vachvanichsanong P (2009) Severe hyperphosphatemia in a newborn with renal insufficiency because of an erroneous medical prescriptions. J Ren Nutr 19:500–502
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kostic, D., Rodrigues, A.B.D., Leal, A. et al. Flow-through peritoneal dialysis in neonatal enema-induced hyperphosphatemia. Pediatr Nephrol 25, 2183–2186 (2010). https://doi.org/10.1007/s00467-010-1570-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-010-1570-6