Severe Hyperphosphatemia After Use of Enemas in Patient with Megacolon
Keywords:
hyperphosphatemia, enema, fluid therapy, megacolonAbstract
Introduction: Hypophosphatemia and hyperphosphatemia represent frequent clinical situations, although in most cases they are mild and little symptomatic alterations. However, acute and severe clinical manifestations may occur and require specific treatment. Hyperphosphatemia is an elevation of serum phosphate above 4.5-5 mg/dl in adults, confirmed by 2 analytical tests. The objective is review the causes, acute management and complications of hyperphosphatemia.
Case presentation: 60-year-old male, with a personal history of myotonic dystrophy, who was admitted to the Anesthesiology Intensive Care Unit with acute respiratory failure and intestinal pseudo-occlusive symptoms with an image of megacolon. After 48 h of administration of phosphate rectal enemas (Casen® enemas), he developed hypernatremia, severe hyperphosphatemia and hypocalcaemia. Continuous veno-venous haemodiafiltration and volemia expansion with fluid therapy were started early. The patient died after 24 h due to multi-organ dysfunction syndrome secondary to toxic megacolon.
Conclusions: Tap water or saline enemas are an alternative to phostat enemas, which may prevent fatal complications in the high-risk group of patient.
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