Sodium phosphate is widely used as a bowel cleansing preparation. Its use is, however, not without risk. It can induce serious adverse effects like hypocalcemia, hyperphosphatemia and renal failure. In this case, a 75-year-old woman without known contraindications developed hypocalcemic tetany, hyperphosphatemia and renal failure after oral sodium phosphate. Asymptomatic hypoparathyroidism owing to previous thyroid surgery was identified as a new contributing risk factor for this complication.