Flow-through peritoneal dialysis in neonatal enema-induced hyperphosphatemia.
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.
Pediatric Nephrology, Department of Pediatrics, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.
Dusan
D
Kostic
Andre Broggin Dutra
AB
Rodrigues
Antônio
A
Leal
Camila
C
Metran
Meire
M
Nagaiassu
Andréia
A
Watanabe
Maria Esther
ME
Ceccon
Uenis
U
Tannuri
Vera Hermina
VH
Koch
D004733:Enema / Q000009:adverse effects*; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006982:Hypertonic Solutions / Q000009:adverse effects; D007231:Infant, Newborn; D010530:Peritoneal Dialysis / Q000379:methods*; D010710:Phosphates / Q000009:adverse effects
D006982:Hypertonic Solutions; D010710:Phosphates