Although not widely recognized, severe hypophosphatemia may result in encephalopathy with confusion, paresthesias, convulsions, and even coma.1.2 Reversal of the neurologic manifestations of hypophosphatemia with intravenous administration of monobasic potassium phosphate has been shown to be effective,2 but is clearly contraindicated in the hyperkalemic patient. We report the use of neutral phosphate enema (Fleet) in a hyperkalemic, hypophosphatemic child with renal failure who was stuporous.
Report of a Case.—A 10½-year-old girl with renal dysplasia and chronic renal failure was vomiting and stuporous. She had undergone cadaveric renal transplantation one year previously, but three months following transplantation, she was admitted to the hospital in coma with generalized convulsions. At that time the serum calcium level was 9.1 mg/dL; phosphorus level, 3.5 mg/dL; and magnesium level, 2.2 mg/dL. Lumbar puncture showed an opening pressure of 43 cm H2O and a clear fluid with normal cell count, glucose and protein content,