Lanthanum carbonate
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Acute liver failure (first report) in a patient with liver cirrhosis: case report A 58-year-old woman developed acute liver failure during treatment with lanthanum carbonate [Fosrenol]. The woman had Child-Pugh stage A liver cirrhosis, a history of alcoholic hepatitis, pancreatitis and secondary diabetes mellitus, and had been receiving haemodialysis for end stage renal failure since May 2007. She began receiving lanthanum carbonate 750mg once daily due to persistently elevated serum phosphorus levels during calcium carbonate treatment. Three weeks later, in December 2007, she presented with decreased consciousness and somnolence requiring hospitalisation. Her skin and conjunctivae were mildly icteric in appearance. She had slurred speech, generalised hyporeflexia and was somnolent, but could be roused with mild stimulation. Following dialysis she had an LDH of 612 U/L, a total alkaline phosphatases level of 118 U/L, a bilirubin level of 2.33 mg/dL, an ammonia level of 166 µg/dL, a phosphorus level of 1.5 mg/dL, a calcium level of 10.4 mg/dL, a serum creatinine level of 3.82 mg/dL, a haemoglobin level of 10.9 g/dL and a platelet count of 114 × 103/mm3. The woman received lactulose enemas and lanthanum carbonate was discontinued. After 2 days, her liver tests and ammonia level had normalised; she made a full recovery. At last follow-up, 6 months after lanthanum carbonate discontinuation, she had experienced no further incidences of liver failure. Author comment: "We assume that the recent introduction of lanthanum carbonate to her therapy can be considered as the responsible factor for this episode of liver failure." de Leeuw K, et al. Lanthanum carbonate possibly responsible for acute liver failure in a patient with Child-Pugh stage A liver cirrhosis. NDT Plus 1: 412-413, No. 6, 801124796 Dec 2008 - Belgium
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of liver failure associated with lanthanum carbonate. The WHO Adverse Drug Reactions database contained no reports of hepatic failure associated with lanthanum carbonate.
0114-9954/10/1230-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 29 Nov 2008 No. 1230
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