Morbid hypocalcemia associated with phosphate enema in a six-week-old infant

A 6-week-old premature infant who was born at 29 weeks of gestation present ed 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 req uired cardiopulmonary resuscitation including chest compressions and medica tions. After stabilization he was transferred to the neonatal intensive car e unit for further management. His initial laboratory tests revealed a seru m calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum pho sphorus 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 pre vent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be add ressed with all parents at early well-child visits to avoid hazardous compl ications of treatments.