Severe Tetany in an Azotemic Child Related to a Sodium Phosphate Enema

Abstract

The potential toxicity of neutral sodium phosphate medications to infants and azotemic children is rarely taken into consideration. Since the sole route of excretion of absorbed phosphate is renal, diminished renal function secondary to chronic renal disease or renal immaturity will limit the ability to excrete a sudden phosphate load. Previous reports document toxicity of phosphate laxatives to normal infants and hypertonic phosphate enemas to patients with Hirschprung's disease. This report presents a 4½-year-old azotemic boy who was admitted with carpopedal spasm and acidosis in the presence of profound hyperphosphatemia, following administration of a sodium phosphate enema for chronic constipation.