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ABSTRACT: We describe a case of severe hyperphosphatemia due to phosphate-based enema for the preparation of coloscopy. A 39-year-old man with end-stage renal failure was admitted with bloody diarrhoea. After administration of a phosphate-based enema, he was seized with general convulsions due to severe hyperphosphatemia and subsequent hypocalcaemia. The patient recovered after daily dialysis and administration of intravenous calcium. The case demonstrates the need to avoid using phosphate-based laxatives in patients with impaired renal function.Ugeskrift for laeger 05/2009; 171(17):1414.