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      • 말기콩팥질환자에서 대장정결을 위한 소량의 인산나트륨 투여 후 발생한 중증 고인산혈증과 저칼슘혈증 1예

        박지훈 중앙대학교 의과대학 의과학연구소 2011 中央醫大誌 Vol.36 No.1/2

        Oral sodium phosphate is currently used for colon preparation prior to colonoscopy or barium enema. Sodium phosphate induces life threatening electrolyte abnormalities in patients with renal insufficiency. We report a case of severe hyperphosphatemia and secondary hypocalcemia due to administration of an oral sodium phosphate-containing bowel preparation (small amounts) in patients with end stage renal disease. A 75-year-old woman with chronic kidney failure without dialysis, was evaluated for a high serum CEA levels. The patient had ingested a 15 mL doses of sodium phosphate solution the previous night, in preparation for a screening colonoscopy. Her serum phosophorus and calcium levels were normal before bowel preparation. Five hours after ingestion of sodium phosphate solution, the patient complained muscle cramping, distal extremity numbness, and tingling sensations. Laboratory evaluation revealed severe hyperphosphatemia and secondary hypocalcemia. Repeated intravenous administration of calcium and insulin, and oral administration of phosphate binding resin did not improve her clinical symptoms and electrolyte abnormalities. These abnormal manifestatioins resolved rapidly after hemodialysis. The patient subsequently underwent colonoscopy without any complications and was diagnosed with cecal cancer.

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