JAMA : the journal of the American Medical Association
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An overdose of a common over-the-counter sodium phosphate enema solution was fatal in an infant. The marked hypernatremia, acidemia, hyperphosphatemia, and hypocalcemia observed before death were also produced in a porcine model. A study using pigs showed that the enema solution was lethal if retained in doses above 20 mL/kg, equivalent to four pediatric-sized enemas in a 2-year-old child. Even normal doses of the enema solution caused measurable changes in serum phosphorus and calcium levels.
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Toxic epidermal necrolysis is an uncommon but severe form of epidermal sloughing with associated mucositis. Treated in a general hospital, it carries a high mortality (25% to 70%) and substantial long-term morbidity. If the patient is referred early to a burn center, where it can be treated with biologic dressings and intensive support care, the mortality can be reduced below 20% and there may be negligible long-term morbidity. We describe 19 patients so treated, with three deaths and no long-term complications.