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May 1980, Vol 134, No. 5 >
Article | May 1980

Phosphate Poisoning Complicating Treatment for Iron Ingestion FREE

Mitchell E. Geffner, MD; Lawrence M. Opas, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, Room 22-315, Marion Davies Childrens Clinic, Center for the Health Sciences, UCLA School of Medicine, Los Angeles, CA 90024 (Dr Geffner).


Am J Dis Child. 1980;134(5):509-510. doi:10.1001/archpedi.1980.02130170059020.
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• A 15-month-old child was treated for iron intoxication with a hypertonic sodium phosphate mixture. Clinical deterioration manifested by fever, obtundation, abdominal distention, dehydration, and hypotension followed soon after the administration of this mixture. Such symptoms may occur with either iron overdosage or with phosphate poisoning. At this time, the patient's serum chemistry values included: iron, 49 μg/dL; phosphorus, 24.6 mg/dL; and calcium, 4.5 mg/dL. The hypocalcemia, hyperphosphatemia, and dehydration were treated with parenteral gluconate calcium, intravenous fluids, and general supportive measures. Although the child had an uneventful recovery despite severe phosphate poisoning, therapeutic alternatives, such as sodium bicarbonate, should be used as adjuncts in the treatment of acute iron ingestion.

(Am J Dis Child 134:509-510, 1980)

REFERENCES

1 +
Stein M, Blayney D, Feit T, et al:  Acute iron poisoning in children: University of California, San Diego, and University Hospital, San Diego (specialty conference) . West J Med 125:289-297, 1976;.
2 +
Oxnard SO, O'Bell J, Grupe WE:  Severe tetany in an azotemic child related to a sodium phosphate enema . Pediatrics 53:105-106, 1974;.
3 +
Chesney RW, Haughton PB:  Tetany following phosphate enemas in chronic renal disease . Am J Dis Child 127:584-586, 1974;.
4 +
Zipser RP, Bischel MD, Abrams DE:  Hypocalcemic tetany due to sodium phosphate ingestion in acute renal failure . Nephron 14:378-381, 1975;.
5 +
Ayala G, Chertow BS, Shah JH, et al:  Acute hyperphosphatemia and acute persistent renal insufficiency induced by oral phosphate therapy . Ann Intern Med 83:520-521, 1975;.
6 +
Moseley PK, Segar WE:  Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease . Am J Dis Child 115:714-718, 1968;.
7 +
Levitt M, Gessert C, Finberg L:  Inorganic phosphate (laxative) poisoning resulting in tetany in an infant . J Pediatr 82:479-481, 1973;.
8 +
Honig PJ, Holtzapple PG:  Hypocalcemic tetany following hypertonic phosphate enemas . Clin Pediatr 14:678-679, 1975;.
9 +
Loughnan P, Mullins GC:  Brain damage following a hypertonic phosphate enema . Am J Dis Child 131:1032, 1977;.
10 +
Sotos JF, Culter EA, Finkel MA, et al:  Hypocalcemic coma following two pediatric phosphate enemas . Pediatrics 60:305-307, 1977;.
11 +
Bachrach L, Correa A, Levin R, et al:  Iron poisoning: Complications of hypertonic phosphate lavage therapy . J Pediatr 94:147-149, 1979;.
12 +
Wiberg JJ, Turner GG, Nuttall FQ:  Effect of phosphate or magnesium cathartics on serum calcium: Observations on normocalcemic patients . Arch Intern Med 138:1114-1116, 1978;.
13 +
Smith MS, Feldman KW, Furukawa CT:  Coma in an infant due to hypertonic sodium phosphate medication . J Pediatr 82:481-482, 1973;.
14 +
Anderson JA, Narasimhan MJ Jr:  Chemical and drug poisoning , in Vaughan VC III, McKay RJ, Nelson WE (eds): Nelson Textbook of Pediatrics , ed 10. Philadelphia, WB Saunders Co, 1975;, pp 1672-1673.
15 +
Dreisbach RH: Handbook of Poisoning: Diagnosis and Treatment , ed 9. Los Altos, Calif, Lange Medical Publications, 1977;, p 426.
16 +
Hebert LA, Lemann J Jr, Petersen JR, et al:  Studies of the mechanism by which phosphate infusions lower serum calcium concentration . J Clin Invest 45:1886-1894, 1966;.
17 +
Finberg L:  Hypernatremic (hypertonic) dehydration in infants . J Engl J Med 289:196-198, 1973;.
18 +
Forman J, Baluarte J, Gruskin AB:  Hypokalemia after hypertonic phosphate enemas . J Pediatr 94:149-152, 1979;.

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References

1 +
Stein M, Blayney D, Feit T, et al:  Acute iron poisoning in children: University of California, San Diego, and University Hospital, San Diego (specialty conference) . West J Med 125:289-297, 1976;.
2 +
Oxnard SO, O'Bell J, Grupe WE:  Severe tetany in an azotemic child related to a sodium phosphate enema . Pediatrics 53:105-106, 1974;.
3 +
Chesney RW, Haughton PB:  Tetany following phosphate enemas in chronic renal disease . Am J Dis Child 127:584-586, 1974;.
4 +
Zipser RP, Bischel MD, Abrams DE:  Hypocalcemic tetany due to sodium phosphate ingestion in acute renal failure . Nephron 14:378-381, 1975;.
5 +
Ayala G, Chertow BS, Shah JH, et al:  Acute hyperphosphatemia and acute persistent renal insufficiency induced by oral phosphate therapy . Ann Intern Med 83:520-521, 1975;.
6 +
Moseley PK, Segar WE:  Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease . Am J Dis Child 115:714-718, 1968;.
7 +
Levitt M, Gessert C, Finberg L:  Inorganic phosphate (laxative) poisoning resulting in tetany in an infant . J Pediatr 82:479-481, 1973;.
8 +
Honig PJ, Holtzapple PG:  Hypocalcemic tetany following hypertonic phosphate enemas . Clin Pediatr 14:678-679, 1975;.
9 +
Loughnan P, Mullins GC:  Brain damage following a hypertonic phosphate enema . Am J Dis Child 131:1032, 1977;.
10 +
Sotos JF, Culter EA, Finkel MA, et al:  Hypocalcemic coma following two pediatric phosphate enemas . Pediatrics 60:305-307, 1977;.
11 +
Bachrach L, Correa A, Levin R, et al:  Iron poisoning: Complications of hypertonic phosphate lavage therapy . J Pediatr 94:147-149, 1979;.
12 +
Wiberg JJ, Turner GG, Nuttall FQ:  Effect of phosphate or magnesium cathartics on serum calcium: Observations on normocalcemic patients . Arch Intern Med 138:1114-1116, 1978;.
13 +
Smith MS, Feldman KW, Furukawa CT:  Coma in an infant due to hypertonic sodium phosphate medication . J Pediatr 82:481-482, 1973;.
14 +
Anderson JA, Narasimhan MJ Jr:  Chemical and drug poisoning , in Vaughan VC III, McKay RJ, Nelson WE (eds): Nelson Textbook of Pediatrics , ed 10. Philadelphia, WB Saunders Co, 1975;, pp 1672-1673.
15 +
Dreisbach RH: Handbook of Poisoning: Diagnosis and Treatment , ed 9. Los Altos, Calif, Lange Medical Publications, 1977;, p 426.
16 +
Hebert LA, Lemann J Jr, Petersen JR, et al:  Studies of the mechanism by which phosphate infusions lower serum calcium concentration . J Clin Invest 45:1886-1894, 1966;.
17 +
Finberg L:  Hypernatremic (hypertonic) dehydration in infants . J Engl J Med 289:196-198, 1973;.
18 +
Forman J, Baluarte J, Gruskin AB:  Hypokalemia after hypertonic phosphate enemas . J Pediatr 94:149-152, 1979;.

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