Fleet PHOSPHO-SODA. Fleet PHOSPHO-SODA ( End stage renal disease ) ( Hyperphophatemia ) ( Hypocalcemia ) ( Hemiparesthesia ) Fleet PHOSPHO-SODA

Transcription

1 ( End stage renal disease ) ( Hyperphophatemia ) ( Hypocalcemia ) ( Hemiparesthesia ) 90 ml PHOSPHOSODA Fleet 78 1

2 237 tonsila 8.4 mg/dl 2.9 mg/dl 90 ml Fleet PHOS PHOSODA 12 ( ) Admission Admission D2 D2 D6 114/55 mmhg WBC / L Hb 7.9 g/dl Platelet 170x10 3 / L GOT/GPT 29/ IU/L Na/K 145/3.8 meq/l glucose 266 mg/dl osmolality 308 mosm/l Blood gas PH PO mmhg PCO mmhg HCO mmol/l Saturation 89.0% 12lead EKG Ca mg/dl P mg/dl Mg mg/dl 3.4 Albumin g/dl monobasic sodium phosphate bibasic sodium phosphate 3.4 mg/dl ( mg/dl ) 3.6 mg/dl 25.0 mg/dl ( mg/dl ) 25.3 mg/dl calcium gluconate ml 72 meq calcium calcium gluconate 10% ( ) 8.5 mg/dl 6.8 mg/dl 1,2,3,4 5 Hirschsprung's disease ( megacolon ) imperforated anus 6,7,8,9,10

3 238 11,12,13,14,15 16 ( pseudotumor (pa cerebri ) pilledema ) H 2PO4 4 1 Fleet PHOS 2 HPO4 / H2PO ( anion gap ) ( tetany ) ( acroparesthesia ) 2 HPO4 PHOSODA H 2PO4 ph 7.4 ph 6 ph molecules Na H2PO4 5 Na 4 H H2PO4 HCO3 metabolic acidosis ) 2 4 HPO4 buffers sodium phosphate 4 H ( high anion gap ( carpopedal spasm ) ( laryngeal stri opisthotonus Trausseau sign QT Fleet PHOS dor ) Chvosteck sign 21 PHODODA 3.4 mg/dl 7 dopamine D 7 11, ( calcium gluconate ) ( parkinsonism ) ( basal ganglia ) ( )

4 ( solubility product ) 22 Fleet PHOS PHOSODA 45ml Fleet PHOSPHOSODA 1ml ml 1.Beloosesky Y, Grinblat J, Weiss A, Grosman B, Gafter U, Chagnac A. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med 03; 163: Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996; 43: Huynh T, Vanner S, Paterson W. Safety profile of 5h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemia. Am J Gastroenterol 1995; 90: DiPalma JA, Buckley SE, Warner BA, Culpepper. Biochemical effects of oral sodium phosphate. Dig Dis Sci 1996; 41: Pitcher DE, Ford RS, Nelson MT, Dickinson WE. Fatal hypocalcemic, hyperphosphatemic, metabolic acidosis following sequential sodium phosphatebased enema administration. Gastrointest Endosc 1997; 46: Reedy JC, Zwiren GT. Enemainduced hypocalcemia and hyperphosphatemia leading to cardiac arrest during induction of anesthesia in an outpatient surgery center. Anesthesiology 1985; 59: Wason S, Tiller T, Cunha C. Severe hyperphosphatemia, hypocalcemia, acidosis, and shock in a 5monthold child following the administration of an adult Fleet enema. Ann Emerg Med 1989; 18: Fass R, Do S, Hixson LJ. Fatal hyperphosphatemia following Fleet PhospoSoda in a patient with colonic ileus. Am J Gastroenterol 1993; 88: Vukasin P, Weston LA, Beart RW. Oral Fleet PhosphoSoda laxativeinduced hyperphosphatemia and hypocalcemic tetany in an adult: report of a case. Dis Colon Rectum 1997; 40: Knobel B, Petchenko P. Hyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (fleet) enema intoxication. J Clin Gastroenterol 1996; 23: Ma KK, Ng CSH, Mui LM, Chan KC, Ng EKW, Chung SCS. Severe hyperphosphatemia and hypocalcemia following sodium phosphate bowel preparation: a forgotten menace. Endoscopy 03; 35: Selva O'Callaghan A, San Jose A, Simeon CP, et al. Fatal hypocalcemia from sodium phosphate enemas. J Am Geriatr Soc 1995; 43: Biberstein M, Parker BA. Enemainduced hyperphosphatemia. Am J Med 1985; 79: Zipser RD, Bischel MD, Abrams DE. Hypocalcemic tetany due to sodium phosphate ingestion in acute renal failure. Nephron 1975; 14: Boivin MA, Kahn SR. Symptomatic hypocalcemia from oral sodium phosphate: a report of two cases. Am J Gastroenterol 1998; 93: Ehrenpreis ED, Wieland JM, Cabral J, Estevez V, Zaitman D, Secrest K. Dig Dis Sci 1997; 42: Kirschbaum B. The acidosis of exogenous phosphate intoxication. Arch Intern Med 1998; 158: Korzets A, Dicker D, Chaimoff C, Zevin D. Lifethreatening hyperphosphatemia and hypocalcemic tetany following the use of fleet enemas. J Am Geriatr Soc 1992; 40: Shaout R, Wolff R, Sellgmann H, Tai Y, Jaffe M. Symptoms of hyperphosphatemia, hypocalcemia, and hypomagnessemia in an adolescent after the oral administration of sodium phosphate in preparation for a colonscopy. Gastrointest Endosc 01; 53: O'Callaghan AS, Jose AS, Simeon CP, et al. Fatal hypocalcemia from sodium phosphate enemas. JAGS 1995; 43: Lewis P. Rowland. Merritt's Neurology 00; 7601, Sutters M, Gaboury CL, Bennett WM. Severe hyperphosphatemia and hypocalcemia: a dilemma in patient management. J Am Society of Nephrol 1996; 7: Helikson MA, Parham WA, Tobias JD. Hypocalcemia and hyperphosphatemia after phosphate enema use in a child. J Pediatr Surg 1997; 32:

5 240 Sodium Phosphate Induced Hyperphosphatemia, Hypocalcemia A Case Report MingHsiu Wu, JyhJou Chen 1, and KuoChing Huang 2 Department of Internal Medicine, Division of Neurology, 1 Division of Gastroenterology, 2 Division of Nephrology, ChiMei Foundation Hospital, Liouying is a laxative commonly used by many physicians for preparation of colonoscopy. Also, it is used frequently for treatment of constipation. Patients and their families can even buy it over the counter. Although it is relatively save, it does cause some adverse side effects which are so significant that physicians who prescribe it and the general public who buy it over the counter should be aware of. Volume depletion and electrolyte disturbance are commonly mentioned. Intravascular volume depletion might deteriorate renal function, and cause overt acute renal failure. Nevertheless, the most important and drastic side effects are electrolyte disturbancehyperphosphatemia and hypocalcemia. We present a 78yearold lady with hemiparesthesia, mimicking stroke after oral intake of undiluted, 90 ml. Later, laboratory data revealed severe hyperphophatemia and hypocalcemia. Hemiparesthesia resolved completely after correction of hyperphophatemia and hypocalcemia. ( J Intern Med Taiwan 05; 16: )