Farmacoriflessioni
Un’inconsapevolezza potenzialmente fatale: il dosaggio dei clismi a base di fosfato nella stipsi
A potentially fatal unawareness: the dosage of phosphate enemas in constipation
Alberto Zampieri1, Sofia De Pra1, Alessandro Zago1, Viola Ceconi1, Egidio Barbi2, Federico Poropat2, Matteo Bramuzzo2, Vincenzo Colacino3, Alessandro Agostino Occhipinti1; PEDs CLISMA study group*
1Universitŕ di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
3Azienda Sanitaria Universitaria Friuli Centrale
Dicembre 2024 - pagg. 649 -652 | DOI: 10.53126/MEB43649
Abstract
While oral laxatives are the first-line treatment for faecal impaction, enemas are frequently used in clinical practice in paediatric emergency departments (PED) and by family paediatricians (FP). Phosphate-containing enemas (PcE) are commonly employed even if at risk of rare but lethal toxicity; recently, a survey has showed limited paediatricians’ awareness of the potential risks related to PcE.
Riassunto
Sebbene il rammollente fecale assunto per via orale rappresenti la terapia di prima linea per il disimpatto fecale, i clismi sono frequentemente utilizzati nella pratica clinica sia nei pronto soccorso pediatrici sia in ambulatorio del pediatra di libera scelta. In particolare, i clismi a base di fosfato sono frequentemente utilizzati ma possono presentare degli effetti avversi, potenzialmente fatali, specialmente in bambini con fattori di rischio; abbiamo eseguito un sondaggio per ottenere una prospettiva riguardo alla consapevolezza dei possibili eventi avversi correlati all’utilizzo dei clismi di fosfato.
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 2011;25:3-18 doi: 10. 1016/j.bpg.2010.12.010.
2. Norbedo S, Bassanese G, Barbieri F, et al. Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department. Pediatr Emerg Care 2017;33(10):e75-e78. doi: 10.1097/PEC. 0000000000001039.
3. Koppen IJN, Vriesman MH, Tabbers MM, et al. Awareness and Implementation of the 2014 ESPGHAN/NASPGHAN Guideline for Childhood Functional Constipation. J Pediatr Gas- troenterol Nutr 2018;66(5):732-7. doi: 10.1097/MPG.0000000000001786.
4. Tabbers MM, Di Lorenzo C, Berger MY, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58(2):258-74. doi: 10.1097/MPG.0000000000000266.
5. Anderson J, Furnival RA, Zhang L, et al. A Comparison of the Efficacy of Enema Solutions in Pediatric Emergency Department Patients. J Emerg Med 2019;57(4):461-8. doi: 10.1016/j.jemermed.2019.07.009.
6. Maisel K, Chattopadhyay S, Moench T, et al. Enema ion compositions for enhancing colorectal drug delivery. J Control Release 2015; 209:280-7. doi: 10.1016/j.jconrel.2015. 04.040
7. Pall H, Zacur GM, Kramer RE, et al. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee. J Pediatr Gastroenterol Nutr 2014;59(3):409-16. doi: 10.1097/MPG. 0000000000000447.
8. Hamilton Smith R, Eddleston M, Bateman DN. Toxicity of phosphate enemas - an updated review. Clin Toxicol (Phila) 2022;60(6): 672-80. doi: 10.1080/15563650.2022.2054424.
9. Mendoza J, Legido J, Rubio S, et al. Systematic review: the adverse effects of sodium phosphate enema. Aliment Pharmacol Ther 2007;26(1):9-20. doi: 10.1111/j.1365-2036. 2007.03354.x.
10. Ladenhauf HN, Stundner O, Spreitzhofer F, et al. Severe hyperphosphatemia after admin- istration of sodium-phosphate containing laxatives in children: case series and systematic review of literature. Pediatr Surg Int 2012; 28(8):805-14. doi: 10.1007/s00383-012-3124-4.
11. Biebl A, Grillenberger A, Schmitt K. Enema-induced severe hyperphosphatemia in children. Eur J Pediatr 2009;168(1):111-2 doi: 10.1007/s00431-008-0705-2.
12. Becknell B, Smoyer WE, O’Brien NF. Hemodialysis for near-fatal sodium phosphate toxicity in a child receiving sodium phosphate enemas. Pediatr Emerg Care 2014;30(11): 814-7. doi: 10.1097/PEC.0000000000000267.
13. Ismail EA, Al-Mutairi G, Al-Anzy H. A fatal small dose of phosphate enema in a young child with no renal or gastrointestinal abnormality. J Pediatr Gastroenterol Nutr 2000;30(2):220-1. doi: 10.1097/00005176-200002000-00025.
14. Marraffa JM, Hui A, Stork CM. Severe hyperphosphatemia and hypocalcemia following the rectal administration of a phosphate-containing Fleet pediatric enema. Pediatr Emerg Care 2004;20(7):453-6. doi: 10.1097/01.pec.0000132217.65600.52.
15. AIFA website. Accessed January 2023.
16. FDA Drug Safety Communication: FDA warns of possible harm from exceeding recom-mended dose of over-the-counter sodium phosphate products to treat constipation FDA. Gov web site. Published January 15, 2016. Accessed January 2023.
17. AIFA website. Clisma Fleet Scheda tecnica.
Corrispondenza: alberto.zampieri6@gmail.com