Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema

Area of Science:

• Nephrology
• Gastroenterology
• Internal Medicine

Background:

• Sodium phosphate enemas are commonly used for bowel preparation and constipation relief.
• These enemas are available both over-the-counter and in hospital settings.
• Physicians should be aware of potential risks associated with their use.

Observation:

• A case study involving an elderly patient with chronic renal failure is presented.
• The patient experienced severe hyperphosphatemia and hypocalcemic tetany with coma post-enema administration.
• This highlights the risks in patients with pre-existing conditions.

Findings:

• Sodium phosphate enemas can lead to dangerous electrolyte imbalances, specifically hyperphosphatemia.
• Hypocalcemia and subsequent complications like tetany and coma are serious risks.
• Older age and renal disease significantly increase patient vulnerability.

Implications:

• Primary care physicians must exercise caution when prescribing sodium phosphate enemas.
• Patients with contraindications (e.g., renal disease, bowel obstruction) should avoid this preparation.
• Safer alternatives, such as tap water or saline enemas, should be considered for high-risk individuals to prevent fatal complications.