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February 20, 1967

Hypernatremic Dehydration From Hypertonic Enemas in Congenital Megacolon

Author Affiliations

From the Department of Surgery, University of California School of Medicine, Los Angeles. Dr. Fonkalsrud is a John and Mary R. Markle scholar in academic medicine.

JAMA. 1967;199(8):584-586. doi:10.1001/jama.1967.03120080118028

FOR MANY DECADES water intoxication from repeated tap water enemas has been recognized as a serious complication occasionally resulting in death in children with congenital megacolon. Although isotonic saline has been recommended as the safest solution for rectal irrigations, additional ions or compounds are frequently added to stimulate peristalsis and produce more complete evacuation. Since chronic constipation in children is frequently managed by repeated enemas, commercial enema preparations have become available.

Scant attention has been directed to the hyperosmotic dehydration which may ensue following repeated use of hypertonic enema solutions in patients with congenital megacolon. These children frequently retain such solutions for many days because of the functional obstruction due to the aganglionic rectal segment. The dilated colon is believed to have a much greater absorptive ability than the normal colon, presumably because of the extremely large mucosal surface.

This report presents an example of acute hypernatremic dehydration which resulted