A high dietary intake of phosphorus is considered by most to be a significant health threat for dialysis patients. Efforts to include the phosphorus content of foods on the nutrition label in the US have, to date, been fruitless. Another source of phosphorus, largely unrecognized, is prescription medications. These may contain phosphorus as indicated on their package label; the amount is not quantified. We examined the labels of the branded forms of 200 of the most widely prescribed medications in Dialysis Clinic centers in the United States and found that 23 (11.5%) contained phosphorus. A sampling of different doses and manufacturers (generic and branded) of these drugs was analyzed for phosphorus content and found levels as high as 111.5 mg/dose (40 mg paroxetine). Notable were the phosphorus content of a generic 10 mg lisinopril (32.6 mg) and a generic 10 mg amlodipine (40.1 mg). The significant potential for iatrogenic injury accruing from the use of these drugs warrants efforts at remediation. Specific information on the phosphorus content of medications used by dialysis population needs to be made available to the dialysis community.
A 40-year-old man with a past medical history of autoimmune pancreatitis, lymphoplasmacytic sclerosing cholangitis, biliary stricture with stent placement, hyperlipidemia, and diabetes mellitus presented with fever for 2 days. Review of systems was negative for nausea, vomiting, poor oral intake, and diarrhea. He denied shortness of breath. Pertinent physical exam findings included fever, jaundice, icteric sclerae, moist oral mucosa, non-tender, non-distended abdomen, and absence of edema in lower extremities. No hepatomegaly was noted on exam.Laboratory tests revealed a serum sodium of 119 mEq/l, potassium of 3.3 mEq/l, chloride of 87 mEq/l, and a serum osmolality of 297 mOsm/kg. Total cholesterol was 2109 mg/dl. His lipid panel, however, demonstrated a low-density lipoprotein level of 68 mg/dl, high-density lipoprotein level of 36 mg/dl, and triglycerides of 299 mg/dl. Electrolytes on a repeat blood sample were checked simultaneously using the indirect ion-selective electrode (ISE) method and the direct ISE method. These results are depicted in the table below.
Patient's laboratory dataElectrolyte values Indirect ion-selective electrode method Direct ion-selective electrode method Sodium
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.