Sodium phosphate
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Nephropathy in elderly patients: 2 case reports Two elderly men developed acute phosphate nephropathy after receiving an oral sodium phosphate solution [Fleet phosphosoda] prior to colonoscopy. An 84-year-old man, who had a history of stage 3 obstructive chronic renal failure, received a standard dose of Fleet phosphosoda [dosage not clearly stated] for bowel cleansing. One week later, he presented with pedal and orbital oedema. His serum levels of urea, creatinine, sodium, potassium, phosphorus and bicarbonate were 346 mg/dL, 9.2 mg/dL, 130 mEq/L, 6.5 mEq/L, 6.6 mg/dL and 15 mEq/L, respectively. Increased cortical echogenicity was seen on a renal ultrasound, and the patient was started on haemodialysis. Kidney biopsy revealed minimal mesangial expansion, with focal interstitial fibrosis and mildly dilated tubules. Von Kossa staining revealed deposits within the cytoplasm of tubular epithelial cells, interstitium and tubular lumen. A diagnosis of acute phosphate nephropathy was made. After 7 months, the man’s renal dysfunction had not improved and he remained on regular haemodialysis. Five days after receiving Fleet phosphosoda [dosage not stated] for bowel cleansing, an 88-year-old man with presented with anuria and lethargy. Upon admission, he was drowsy, hypotensive, oliguric and apyretic. The patient had a painful and distended abdomen, and a chest exam revealed inspiratory crackles. He had the following test results: serum creatinine 3.45 mg/dL, serum urea 106 mg/dL, serum calcium 4.5 mg/dL, LDH 3028 U/L, CRP 28.2 mg/dL, bicarbonate 13.3 mEq/L and lactate 7.5 mmol/L. A renal ultrasound revealed echogenicity and a chest radiograph showed interstitial oedema. The man was assumed to have severe urinary sepsis and acute kidney injury secondary to sepsis and phosphate nephropathy. Despite treatment with IV fluids and antibacterials, the patient did not improve and conservative measures were taken. Santos P, et al. Acute phosphate nephropathy after bowel cleansing: still a menace. Nefrologia 30: 702-4, No. 6, 2010. Available from: URL: http:// 803049322 dx.doi.org/10.3265/nefrologia.pre2010.jul.10544 - Portugal
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Reactions 26 Feb 2011 No. 1340
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