calcium gluconate antidote for hyperphosphatemia

His clinical course over the next 24 hours, showed having tetany episodes that improved with additional calcium, but eventually his hypocalcemia, hypoglycemia and hyperphoshatemia all resolved. He was treated for presumed sepsis and hypocalcemia, hypoglycemia, and hyperphosphatemia with aggressive hydration, calcium gluconate, ampicillin, gentamycin and metronidazole, and rectal irrigation.

The family history was negative for genetic, metabolic, neurologic or gastrointestinal problems. He had been treated with oral polyethylene glycol and occasional enemas for constipation. A previous rectal biopsy had shown ganglion cells and his neonatal screening test was normal including for cystic fibrosis. The past medical history that became available later revealed a term infant who stooled around birth but had problems with constipation. The differential diagnosis at that time included sepsis with ileus, volvulus, appendicitis with perforation (unlikely due to age), pseudoobstruction, bowel perforation, and metabolic abnormalities. The pertinent laboratory evaluation at that time showed a glucose of 23 mg/dl, ionized calcium of 1.3 (normal 4.5-5.6 mg/dl), total calcium of 7.4 (normal 9.0-10.5 mg/dl), phosphorous of 28 (normal 3-4.5 mg/dl) and magnesium of 1.9 (normal 1.8-3.0 mg/dl). He also had intermittent extremity spasms especially of his hands and feet. He had a grossly distended abdomen without bowel sounds. In the pediatric intensive care unit the pertinent physical exam showed a temperature of 99.8☏, heart rate of 128, respiratory rate of 22, blood pressure of 104/62 with a capillary refill of 3-4 seconds and pale color. After intubation his heart rate increased to normal and he had spontaneous respirations. Upon arrival at the children’s hospital the patient had bradycardia and a respiratory arrest. He continued to have abdominal distention and the decision to transfer him was made. The patient received the enema but had no fecal return.

The local emergency room physicans had contacted a local pediatrician who ordered an enema for the patient. A 6-month-old male came to the floor of a regional children’s hospital after being transferred from a local emergency room because of abdominal distention.

Calcium gluconate antidote for hyperphosphatemia