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How would you answer this question?
The nurse preparing to administer a dose of PhosLo to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient?
a. Sodium
b. Magnesium
c. Potassium
d. Phosphorus
The correct answer is "d" phosphorus.
Calcium acetate (PhosLo) binds phosphorus in the intestine forming calcium phosphate which is insoluble and is then excreted in the feces.
Patients with chronic kidney disease often develop increased phosphate levels due to the inability of the kidney to excrete phosphorus. Phosphorus is contained in many foods, so the patient is getting it regularly in her diet. In chronic kidney disease the kidney cannot excrete phosphorus and it begins to build up.
Often, hyperphosphatemia is asymptomatic, but high levels in the bloodstream can drive serum calcium levels lower and can cause hypocalcemia which is associated with potential life-threatening side effects such as laryngeal spasm and seizures.
Binding phosphorus in the intestine decreases absorption and lowers phosphorus levels in the bloodstream resulting in normalization in serum calcium levels as well. PhosLo would be contraindicated if the calcium level was increased because some calcium gets absorbed from the calcium acetate.
Congratulations to Nicole Bodin who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Nicole!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
PS. PJs, bunny slippers, and professional education? Call about our web-based seminars that you can attend from home! (800) 990-2629.
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