Enema-induced hypocalcemia and hyperphosphatemia leading to cardiac arrest during induction of anesthesia in an outpatient surgery center

Hypocalcemia and hyperphosphatemia have been reported secondary to the use of hypertonic phosphate enemas and gavage with resultant tetany an coma. Prolongation of the Q-T interval and complete heart block have occurred from hypocalcemia. In this instance, in an outpatient surgical center, general anesthesia was induced in the presence of unsuspected hypocalcemia and hyperphosphatemia, and cardiac arrest followed.