Enema, hyperphosphatemia with

The normal range of free inorganic phosphate, in plasma, is expressed as 2.0-4.3 mg phosphorus/1(K) ml. Hyperphosphatemia is defined as the condition where plasma phosphate levels rise above 5.0 mg phosphorus/100 ml. Hyperphosphatemia can result from overuse of laxatives or enemas that contain phosphate. Phosphate enemas are used in the hospital prior to examinations of the intestines for disease, such as colon cancer. However, hyperphosphatemia has occurred in the home situation with accidental drinking of enema formulas. Enema drinking... 

A 77-year-old patient with diverticular disease, who received phosphate enemas in preparation for a barium enema, developed hyperphosphatemia and hypocalcemic coma (13). 

A 46-year-old woman, with hepatic encephalopathy complicating cirrhosis due to hepatitis B and C infection, developed fatal hypernatremia, hyperphosphatemia, and hypocalcemia following the erroneous administration of a total of six sodium phosphate enemas (133 ml each) over 36 hours (16). 

Rohack JJ, Mehta BR, Subramanyam K. Hyperphosphatemia and hypocalcemic coma associated with phosphate enema. South Med J 1985 78(10) 1241-2. 

Medications are another cause of hyperphosphatemia. Excessive intravenous or oral administration of phosphorus is an obvious potential cause of elevated serum phosphate concentrations. Phosphate-containing enemas increase concentrations, especially in those with renal insufficiency. Intravenous or oral vitamin D therapy can increase absorption of phosphorus in the gastrointestinal tract by up to 50%. Bisphosphonate therapy is associated with increased serum phosphate concentrations. Acute phosphorus poisoning as a result of ingestion of laundry detergents is a rare and often unrecognized cause of elevated phosphate concentrations. 

A 76-year-old woman with rectal bleeding underwent sigmoidoscopy after taking two sachets of sodium phosphate solution (Fleet Phospho-Soda ) and sodium phosphate enema (Fleet Ready-To-Use ) [83 ]. She was then given mesalazine for chronic active ulcerative cohtis and 2 days later developed acute renal insufficiency, with normocalcemia and mild hyperphosphatemia. Mesalazine was replaced with prednisolone enemas. Renal biopsy showed normal glomeruli but widespread tubular calcification with high phosphate content the tubules were dilated and the tubular epithelium was flattened, with minimal lymphocytic infiltration. 

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