Hyponatremia Induced By A Phosphate Enema

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Hyponatremia

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
Sir, i am giving a personal experience of having a case of hyponatremia induced by a phosphate enema. 7 year old girl was given 75 ml of phosphate enema for evacuating the hard impacted stools. Within 5 minutes she started to vomit and became very lethargic. Sodium was 122, and pottassium was 2.9. This was managed with 500ml of normal saline given over 1hr, ORS by mouth. After the infusion sodium was 132 and K+ 3.4 and she was symptomatically much better. My queries are 1.Is this complication following phosphate enema, common? 2.Was the dose used too high ( 75 ml ,weight was 25.7 kg) 3.Was the management right? Should i have done anything more? 4.What is the most safe and effective enema in children. please give your valuable suggestions thanking you, yours sincerely Dr.manoj chandran.
Answer
Hyponatermia is a known complication in phosphate enema. Sodium biphosphate and sodium phosphate is available as an enema specifically for use in children aged 2 to 11 years. The dose is usually half the adult dose (about 60 ml). Hyponatremia should not be corrected very rapidly unless the child has convulsions. The aimed serum sodium level should be an increase in 10Meq/L in 24 hours. Thus with a serum sodium of 122, you must target to achieve a level of 132-135 in next 25 hours (a rise of 0.5meq in half an hour). Apart from enema, one can use glycerine suppository or milk of magnesia as laxative in children. Back to All Questions

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