Enema-induced severe hyperphosphatemia in children
ABSTRACT We report the case of a 13-year-old boy with Costello syndrome and chronic constipation who received phosphate-containing Fleet-pediatric enemas at regular intervals. The day before admission he was given four enemas for severe constipation. Within 24 h the boy had developed severe hyperphosphatemia (phosphate 17.75 mmol/L), hypertonic dehydration (sodium 171 mmol/L) and severe hypocalcemia (calcium 0.56 mmol/L). With early intervention and treatment, the child survived without sequelae. Osmotically acting hypertonic phosphate enemas may result in severe toxicity. Children with developmental delay often display bowel dysfunction and chronic constipation and are therefore high-risk patients. The accepted opinion-that these enemas are not absorbed and therefore systemically inactive-is not true. Physicians should be aware of the potentially lethal complications of this treatment, which is part of everyday clinical practice.
- Acta Endoscopica 09/2012; 42(4). DOI:10.1007/s10190-012-0245-5 · 0.16 Impact Factor
Article: Clinical ToxicologyAcademic Medicine 12/1964; 40(1):69. · 3.47 Impact Factor
Conference Paper: Bandwidth-efficient waveforms for line-of-sight communications[Show abstract] [Hide abstract]
ABSTRACT: A family of power- and bandwidth-efficient waveforms, suitable for fading multipath channels is described. A relatively high rate serially-concatenated convolutional code is paired with either QAM or non-recursive partial-response CPM. When using CPM, the receiver employs a simplified soft-output demodulator. The performance and implementation impacts of multiple receiver architectures, including iterative demapping, iterative demodulation, and iterative equalization are examined. A block equalizer is used to mitigate intersymbol interference effects. The waveform permits a relatively simple, yet flexible, receiver design, that achieves high performance in real-world channels. Performance and implementation considerations are discussed.Military Communications Conference, 2003. MILCOM 2003. IEEE; 11/2003