Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing Fleet pediatric enema

Pediatr Emerg Care. 2004 Jul;20(7):453-6. doi: 10.1097/01.pec.0000132217.65600.52.


Background: Toxicity secondary to rectally administered hypertonic phosphate solution in patients with normal renal function is rarely reported in the literature. We report a case of electrolyte disturbance and seizure secondary to the rectal administration of 2 Fleet pediatric enemas.

Case report: A 4-year-old white female with spinal muscular atrophy and chronic constipation was brought to the emergency department with complaints of lethargy and difficulty breathing following the administration of 2 Fleet pediatric enemas. In the emergency department, physical examination was significant for a depressed level of consciousness and shallow respirations. A basic metabolic profile was significant for a calcium of 3.3 mg/dL, phosphate of 23 mg/dL, and sodium of 153 mEq/L. Arterial blood gases revealed a pH of 7.24, Pco2 of 38 mm Hg, Po2 of 220 mm Hg. Electrocardiogram revealed a prolonged QT interval of 340 milliseconds with a corrected QT interval of 498 milliseconds. Sixteen hours postexposure, she experienced a generalized seizure unresponsive to multiple doses of lorazepam and responsive only to 100 mg of intravenous calcium chloride. Two days after presentation, the patient experienced complete resolution of symptoms.

Conclusion: Osmotically acting hypertonic phosphate enemas can result in severe toxicity if retained. This is true even in patients without predisposing risk factors.

Publication types

  • Case Reports

MeSH terms

  • Acidosis / chemically induced
  • Administration, Rectal
  • Calcium Chloride / therapeutic use
  • Child, Preschool
  • Consciousness Disorders / chemically induced
  • Constipation / etiology
  • Constipation / therapy
  • Dyspnea / chemically induced
  • Enema / adverse effects*
  • Epilepsy, Generalized / chemically induced
  • Female
  • Humans
  • Hypernatremia / chemically induced
  • Hypertonic Solutions / adverse effects*
  • Hypocalcemia / chemically induced*
  • Hypocalcemia / drug therapy
  • Intestinal Absorption
  • Muscular Atrophy, Spinal / complications
  • Phosphates / administration & dosage
  • Phosphates / adverse effects*
  • Phosphates / blood*
  • Phosphates / pharmacokinetics


  • Hypertonic Solutions
  • Phosphates
  • Calcium Chloride