Abstract
The most well known complications of fleet enema solution are cardiac insufficiency, renal failure, water-electrolyte imbalance, and ileus. A 7-y-old girl with phenylketonuria and long-term constipation was admitted to the emergency department with symptoms of seizure, vomiting and abdominal distention. Laboratory results revealed hypocalcemia and hyperphosphatemia. ECG findings showed normal sinus rhythm and prolonged QT interval. At the follow-up, the patient’s abdominal distention was markedly increased. She was evaluated for a surgical pathology and, this was considered unlikely. Intra-abdominal pressure (IAP) was 19.5 mmHg. Gastric and colonic decompression, intravenous 10 % calcium gluconate were applied. After 2 d of treatment, the patient’s condition became stable, and serum calcium and phosporus normalized to 8.8 mg/dl and 4.0 mg/dl, respectively. Abdominal distention regressed and the last IAP measurement was 3.5 mmHg. Thus, IAP measurements are a useful adjunct in clinical follow-up of patients with progressive abdominal distention due to phosphate enema use.
References
Maraffa JM, Hui A, Stork CM. Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing fleet pediatric enema. Pediatr Emerg Care. 2004;20:453–6.
Biebl A, Grillenberger A, Schmitt K. Enema induced severe hyperphosphatemia in children. Eur J Pediatr. 2009;168:111–2.
Helikson MA, Parham WA, Tobias JD. Hypocalcemia and hyperphosphatemia after phosphate use in a child. J Pediatr Surg. 1997;32:1244–6.
Gallagher JJ. Intrabdominal hypertension: detecting and managing lethal complication. AACN Adv Crit Care. 2010;21:205–19.
Malbrain ML, De Waele JJ, De Keulenaer BL. What every ICU clinician need to know about the cardiovascular effects caused by abdomianl hypertension. Anaesthesiol Intensive Ther. 2015;47:388–99.
Malbrain ML, Cheatham ML, Kirkpatrik A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32:1722–32.
Cheatham ML, Malbrain ML, Kirkpatrik A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–62.
Contributions
BA cared for the patient, reviewed the literature and wrote the manuscript. BA, MK, DA and SK conceptualised the manuscript, reviewed the literature and contributed to the writing. AY evaluated the patient’s radiologic findings. BA will act as guarantor for the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None.
Source of Funding
None.
Rights and permissions
About this article
Cite this article
Akyildiz, B., Kondolot, M., Yikilmaz, A. et al. Ileus and Intra-Abdominal Hypertension due to Phosphate- Containing Enema. Indian J Pediatr 83, 1346–1348 (2016). https://doi.org/10.1007/s12098-016-2166-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-016-2166-3