Hypernatremic dehydration from hypertonic enemas in congenital megacolon

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Abstract
Hypernatremic dehydration was observed following administration of hypertonic Na enema solutions (FL (Fleet Enemas) to a 4-year-old boy with congenital megacolon. Similar changes occurred in dogs with rectal ligation who were given intraco-lonic hypertonic fluids. Several factors favor fluid and ion shifts between enema solutions and the circulation in patients with aganglionic megacolon. Hypertonic enema solutions in such patients may produce rapid massive shifts of body water into the intestine. Proper treatment of such hypernatremic dehydration includes prompt fluid replacement and removal of the enema solution. Isotonic NaCl or gelatin (7%) is recommended for safe administration of enemas to children with chronic constipation. Hypertonic sodium solutions and hypertonic contrast solutions such as meglumine diatrizoate (Gastrografin) should be avoided or used cautiously in such patients. Retained enema solutions may be removed by a large, soft rectal tube.

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