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September 1977

Brain Damage Following a Hypertonic Phosphate Enema

Author Affiliations

Clinical Pharmacology and Intensive Care Units Royal Children's Hospital Parkville 3052 Melbourne, Australia

Am J Dis Child. 1977;131(9):1032. doi:10.1001/archpedi.1977.02120220098018

Recent reports have indicated that hypertonic phosphate enemas may result in electrolyte disturbances particularly in young infants with certain associated diseases. In these patients long-term sequelae did not occur. We report the case of an infant with unsuspected colonic ulceration and gross dilation who sustained severe electrolyte imbalance shortly after receiving a hypertonic phosphate enema. Severe and probably permanent brain damage was sustained.

Report of a Case.—This infant had high rectal atresia with rectovestibular fistula and dysplasia of the left upper urinary tract. At age 5 months, a sacroperineal rectoplasty was performed with excision of the fistula. Renal function assessed by serum electrolytes, urea, and creatinine was within normal limits and psychomotor development was appropriate for age. Gross constipation was noted at routine follow-up examination at the age of 9 months, at which time the infant weighed 7.4 kg. A Coloxyl enema, 120 ml of a 1:24 dilution of

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