Encephalopathy caused by lanthanum carbonate

Fraile, Pilar Quijada; Cacharro, Luis M.; García-Cosmes, Pedro; Rosado, Consolación; Tabernero, J. M.

doi:10.1093/ndtplus/sfr003

“…Fraile et al. have recently published a confusional syndrome, which resolved after discontinuation of the drug . They discover high level of lanthanum carbonate in the cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

Radio‐opaque fecal impaction and pseudo‐occlusion in a dialyzed patient taking lanthanum carbonate

Müller

¹

,

Muller

²

,

Sissoko

³

et al. 2011

Hemodialysis International

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Lanthanum therapy is an efficient therapy of hyperphosphoremia by chelating phosphore in the digestive tract. Lanthanum is a silvery white metallic element that belongs to group 3 of the periodic table. This drug is lightly absorbed and has low water solubility. It should be borne in mind that abdominal X-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of imaging agents. This characteristic is suggested to confirm adherence of the patient by doing an abdominal X-ray. We describe in our case a particular good compliant patient with slow digestive transit, which ends by pseudo-occlusion.

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“…85,122 Currently, there have been conflicting studies that suggest La is able to cross the blood-brain barrier and deposit in brain tissue, however, other studies have disputed this claim. 121,123,124 Therefore, more studies are required to further investigate this issue as there are many sites in which La is deposited and challenges the notion that La is minimally absorbed in the gut as its bioavailability has been reported to be minimal at 0.00127%. 125 Future work should investigate whether there are any correlations that exist between organ deposition with bone La retention as this would provide greater insight into La uptake and retention in various storage sites within the body.…”

Section: Investigating Possible Correlation Of La Retention Between I...mentioning

confidence: 99%

In vivo detection of lanthanum via x-ray fluorescence

Nguyen¹

2023

Preprint

0

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Phosphate binding drugs are crucial in reducing blood phosphate concentrations in individuals with end-stage renal disease (ESRD) to prevent hyperphosphatemia. While many phosphate binding drugs exist, lanthanum carbonate [La2(CO3)3, LaC] has been reported to be better tolerated than previously used calcium- and aluminum-based phosphate binders. However, since large doses ranging up to 3750 mg LaC/day is orally administered to ESRD patients, concerns have been raised as to whether chronic exposure to lanthanum (La) may lead to La toxicity on bone health. In this thesis, a robust x-ray fluorescence (XRF) detection system was developed and can be potentially used to non-invasively measure La in ESRD patients. The first step in testing the feasibility of the system was by measuring La in a series of bone mimicking hydroxyapatite phantoms doped with known concentrations of La. The sensitivity of the detection system was evaluated by investigating the minimum detection limit of the system. Initially a 90° irradiation-detection geometry was utilized but was deemed inadequate for in vivo measurements due to challenges in experimental reproducibility. Therefore, a 180° backscatter irradiation-detection geometry was adopted for all subsequent measurements. Since it is anticipated that the developed XRF system will be used clinically to measure bone La concentrations in the ESRD population who are administered LaC, interpatient variability such as amount of overlying tissue thickness at the measurement site, bone size and subject-source movement will affect the intensity of the La x-ray signal. Therefore, a coherent normalization correction procedure was investigated to determine whether these factors could be accounted to allow the true value of the bone La concentration to be estimated during in vivo measurements involving living subjects. In addition, a dosimetry study was performed to determine the radiation dose delivered to a participant during a 2000 s XRF measurement. Lastly, since literature data on the natural accumulation of La in bone from the environment and diet is limited, an ex vivo study was performed on 10 excised human cadavers obtained from deceased donors with no previous exposure to La. Based on these studies, this dissertation presents the development of an XRF system that is robust, safe and has the potential to determine in vivo bone La concentrations in the ESRD population who are orally administered LaC.

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“…85,122 Currently, there have been conflicting studies that suggest La is able to cross the blood-brain barrier and deposit in brain tissue, however, other studies have disputed this claim. 121,123,124 Therefore, more studies are required to further investigate this issue as there are many sites in which La is deposited and challenges the notion that La is minimally absorbed in the gut as its bioavailability has been reported to be minimal at 0.00127%. 125 Future work should investigate whether there are any correlations that exist between organ deposition with bone La retention as this would provide greater insight into La uptake and retention in various storage sites within the body.…”

Section: Investigating Possible Correlation Of La Retention Between I...mentioning

confidence: 99%

In vivo detection of lanthanum via x-ray fluorescence

Nguyen¹

2023

Preprint

0

View full text Add to dashboard Cite

Phosphate binding drugs are crucial in reducing blood phosphate concentrations in individuals with end-stage renal disease (ESRD) to prevent hyperphosphatemia. While many phosphate binding drugs exist, lanthanum carbonate [La2(CO3)3, LaC] has been reported to be better tolerated than previously used calcium- and aluminum-based phosphate binders. However, since large doses ranging up to 3750 mg LaC/day is orally administered to ESRD patients, concerns have been raised as to whether chronic exposure to lanthanum (La) may lead to La toxicity on bone health. In this thesis, a robust x-ray fluorescence (XRF) detection system was developed and can be potentially used to non-invasively measure La in ESRD patients. The first step in testing the feasibility of the system was by measuring La in a series of bone mimicking hydroxyapatite phantoms doped with known concentrations of La. The sensitivity of the detection system was evaluated by investigating the minimum detection limit of the system. Initially a 90° irradiation-detection geometry was utilized but was deemed inadequate for in vivo measurements due to challenges in experimental reproducibility. Therefore, a 180° backscatter irradiation-detection geometry was adopted for all subsequent measurements. Since it is anticipated that the developed XRF system will be used clinically to measure bone La concentrations in the ESRD population who are administered LaC, interpatient variability such as amount of overlying tissue thickness at the measurement site, bone size and subject-source movement will affect the intensity of the La x-ray signal. Therefore, a coherent normalization correction procedure was investigated to determine whether these factors could be accounted to allow the true value of the bone La concentration to be estimated during in vivo measurements involving living subjects. In addition, a dosimetry study was performed to determine the radiation dose delivered to a participant during a 2000 s XRF measurement. Lastly, since literature data on the natural accumulation of La in bone from the environment and diet is limited, an ex vivo study was performed on 10 excised human cadavers obtained from deceased donors with no previous exposure to La. Based on these studies, this dissertation presents the development of an XRF system that is robust, safe and has the potential to determine in vivo bone La concentrations in the ESRD population who are orally administered LaC.

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Encephalopathy caused by lanthanum carbonate

Cited by 6 publications

References 10 publications

Radio‐opaque fecal impaction and pseudo‐occlusion in a dialyzed patient taking lanthanum carbonate

Radio‐opaque fecal impaction and pseudo‐occlusion in a dialyzed patient taking lanthanum carbonate

In vivo detection of lanthanum via x-ray fluorescence

In vivo detection of lanthanum via x-ray fluorescence

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