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Phospho-soda-induced symptomatic hypocalcemia in a patient with cystic fibrosis and vitamin D malabsorption.

Two agents commonly used in bowel preparation for gastroenterological, radiological, and surgical procedures are polyethylene glycol and sodium phosphate solutions. Both agents have similar efficacy (1); however, a sodium phosphate regimen generally requires a smaller volume for effect and thus may be associated with improved patient compliance (2). Adverse effects of sodium phosphate solutions are generally limited to the gastrointestinal tract and include abdominal discomfort, bloating, nausea, cramping, and vomiting. Abnormalities in serum electrolytes—including hyperphosphatemia, hypocalcemia, hypokalemia, hypernatremia, and metabolic acidosis—also have been reported (3). With the rapid delivery of high concentrations of phosphate to the intestine, asymptomatic hyperphosphatemia occurs in approximately 25% of individuals with normal renal function within the first several hours after ingestion (4). The degree of hyperphosphatemia increases with decreasing glomerular filtration rate and older age (5). Symptomatic hyperphosphatemia with consequent decrease in ionized serum calcium is rare, but when it occurs may present as abdominal pain, emesis, dizziness, muscle cramping, seizures, coma, or cardiac dysrhythmias (6). These symptoms usually are associated with inappropriately high dosing of oral or rectal sodium