Tanıl KENDİRLİ, Çağlar ÖDEK, Eda Didem KURT-ŞÜKÜR, Onur TELLİ, Ayhan YAMAN, Berk DİVİSİON OF PEDİATRİC UROLOGY DEPARTMENT OF UROLOGY ANKARA UNİVERSİTY FACULTY OF MEDİCİNE ANKARA TURKEY, Z Birsin ÖZÇAKAR

Severe hyperphosphatemia after oral laxative administration in a 7-year-old patient

Sodium phosphate based laxatives are commonly used for constipationand pre-procedural bowel cleansing. Phosphate intoxication related withthese preparations is well recognized. Herein, we present a case of severehyperphosphatemia and seizure in a 7-year-old male patient after administrationof an oral sodium phosphate based laxative. At the time of admission, serumphosphorus level was 25.6 mg/dl. Aggressive fluid therapy was started.Although serum phosphorus level decreased to 20.9 mg/dl eight hours afteradmission, hemodialysis was performed because of the preexisting renaldisease and declined glomerular filtration rate. Serum phosphorus level andblood gas analysis returned to normal after hemodialysis and the patientwas discharged on hospital day two. In conclusion, sodium phosphate basedlaxatives should be used carefully in patients with preexisting renal diseases.Intravenous hydration and correction of hypocalcemia are important componentsof treatment. Hemodialysis is indicated in patients with renal failure.

PDF

___

1. Adamcewicz M, Bearelly D, Porat G, Friedenberg FK. Mechanism of action and toxicities of purgatives used for colonoscopy preparation. Expert Opin Drug Metab Toxicol 2011; 7: 89-101.
2. Szoke D, Dolci A, Genderini A, Panteghini M. Fatal electrolyte abnormalities following enema administration. Clin Chem 2012; 58: 1515-1518.
3. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24: 743-752.
4. Leteurtre S, Martinot A, Duhamel A. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362: 192-197.
5. Ainley EJ, Winwood PJ, Begley JP. Measurement of serum electrolytes and phosphate after sodium phosphate colonoscopy bowel preparation: an evaluation. Dig Dis Sci 2005; 50: 1319-1323.
6. Lieberman D, Ghormley J, Flora K. Effects of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1995; 43: 467-469.
7. Ismail EA, Al-Mutairi G, Al-Anzy H. A fatal small dose of phosphate enema in a young child with no renal or gastrointestinal abnormality. J Pediatr Gastroenterol Nutr 2000; 30: 220-221.
8. Arıkan H, Güler D, Birdal G, Et al. Massive hyperphosphatemia in a patient with neuronal intestinal dysplasia after bowel preparation with oral sodium phosphate. Ren Fail 2013; 35: 875-878.
9. Ladenhauf HN, Stundner O, Spreitzhofer F, Deluggi S. Severe hyperphosphatemia after administration of sodium-phosphate containing laxatives in children: case series and systematic review of literature. Pediatr Surg Int 2012; 28: 805-814.
10. Malberti F. Hyperphosphatemia: treatment options. Drugs 2013; 73: 673-688.