US EPA

2067584 

Journal Article 

Fatal hyperphosphatemia after oral phosphate overdose in a premature infant 

Perlman, JM 

1997 

Yes 

American Journal of Health-System Pharmacy
ISSN: 1079-2082
EISSN: 1535-2900 

IPA/98/1136111 

J 

REF 11 

2488-2490 

English 

9359956 

IPA COPYRIGHT: ASHP Fatal hyperphosphatemia following erroneous administration of 11 mmol of sodium phosphate dibasic (sodium phosphate) instead of the intended 11 mg is reported in a 62-day-old premature infant who was given the drug to prevent bone demineralization; the patient was initially observed to be irritable and to have respiratory difficulties, which were attributed to administration of Tetrammune, a combined diphtheria, tetanus toxoids, pertussis, and Haemophilus b oligosaccharide vaccine. The patient was initially treated with an increase in the intravenous (IV) fluid intake of 5% dextrose and 0.225% sodium chloride and administration of enteral aluminum hydroxide suspension. A central line was placed and an exchange transfusion was initiated. She developed bradycardia and was given 100 mg/kg of calcium gluconate by IV injection, which corrected the heart rate. At the midpoint of the exchange transfusion, although the serum phosphate concentration had decreased, the infant developed persistent bradycardia, which was unresponsive to intensive resuscitation, and died. Autopsy revealed disseminated cytomegalovirus infection of the lung, liver, and kidneys. Toxicology screens were unremarkable.