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PEDIATRICS Vol. 106 No. 3 September 2000, p. e37

ELECTRONIC ARTICLE:
Morbid Hypocalcemia Associated With Phosphate Enema in a Six-Week-Old Infant

Received Jan 31, 2000; accepted Apr 4, 2000.

Dawn M. Walton*, Dagger , David C. Thomas*, Dagger , Hany Z. Aly*, Dagger , and Billie L. Short*, Dagger

From the * Department of Neonatology, Children's National Medical Center; and the Dagger  Newborn Service Department, George Washington University Medical Center, Washington, DC.

A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization.

Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.

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