HYPERPHOSPHATEMIC HYPOCALCEMIC COMA CAUSED BY HYPERTONIC SODIUM-PHOSPHATE (FLEET) ENEMA INTOXICATION

We describe an elderly woman with a deep hyperphosphatemic hypocalcemi c coma, hypernatremia, hypokalemia, metabolic acidosis, pancytopenia a nd respiratory and circulatory failure secondary to phosphate intoxica tion following the overdose administration of hypertonic sodium phosph ate enema. The causes of increased colonic retention and absorption an d decreased renal excretion are discussed. We recommend the use of the safer and less toxic cathartic medications or at least a very cautiou s use of such enemas in anyone with renal failure.