• Brian Becknell, William E Smoyer, and Nicole F O'Brien.
• From the *Nephrology Section, †Center for Clinical and Translational Research, The Research Institute, and ‡Critical Care Section, Nationwide Children's Hospital, Columbus, OH.
• Pediatr Emerg Care. 2014 Nov 1;30(11):814-7.

ObjectiveThis study aimed to demonstrate the importance of considering hemodialysis as a treatment option in the management of sodium phosphate toxicity.MethodsThis is a case report of a 4-year-old who presented to the emergency department with shock, decreased mental status, seizures, and tetany due to sodium phosphate toxicity from sodium phosphate enemas.ResultsTraditional management of hyperphosphatemia with aggressive hydration and diuretics was insufficient to reverse the hemodynamic and neurological abnormalities in this child. This is the first report of the use of hemodialysis in a child without preexisting renal failure for the successful management of near-fatal sodium phosphate toxicity.ConclusionsHemodialysis can safely be used as an adjunctive therapy in sodium phosphate toxicity to rapidly reduce serum phosphate levels and increase serum calcium levels in children not responding to conventional management.

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