Hyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (Fleet) enema intoxication

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