Sevelamer Carbonate Crystal-Induced Colitis
Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an un...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2020/4646732 |
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| author | T. Lai A. Frugoli B. Barrows M. Salehpour |
| author_facet | T. Lai A. Frugoli B. Barrows M. Salehpour |
| author_sort | T. Lai |
| collection | DOAJ |
| description | Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an underrecognized adverse effect of a phosphate binder, sevelamer carbonate, inducing colitis in a 47-year-old male with insulin-dependent diabetes complicated by end-stage renal disease. He presented for recurrent abdominal pain with associated nausea and was found to have multiple circumferential lesions on computed tomography including distal ascending, transverse, and proximal descending colon. Colonoscopy demonstrated nearly obstructing lesions worrisome for colonic ischemia or inflammatory bowel disease. Pathological review of histology demonstrated ragged colonic mucosa with ulcerative debris and nonpolarizing crystalline material at the sites of ulceration, morphologically consistent with the phosphate binder, sevelamer carbonate. Sevelamer carbonate was discontinued, and the patient was transitioned to calcium carbonate with strict dietary restrictions. His symptoms improved with the cessation of sevelamer, and he was subsequently discharged home. He eventually underwent renal transplant without redevelopment of symptoms. Recognition of this underreported complication of sevelamer carbonate, phosphate binder, is of utmost importance in directing appropriate therapy with cessation of this medication in the setting of gastrointestinal complaints or more specifically enteritis and colitis. Clinicians providing care to end-stage renal patients taking either sevelamer and/or sodium polystyrene sulfonate should have increased awareness of the possible gastrointestinal side effects. |
| format | Article |
| id | doaj-art-981738d72826412ab6ca0366d84b8e62 |
| institution | Kabale University |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-981738d72826412ab6ca0366d84b8e622025-02-03T06:45:49ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362020-01-01202010.1155/2020/46467324646732Sevelamer Carbonate Crystal-Induced ColitisT. Lai0A. Frugoli1B. Barrows2M. Salehpour3Community Memorial Health System, Graduate Medical Education, Ventura, CA, USACommunity Memorial Health System, Graduate Medical Education, Department of Internal Medicine, Pacific Inpatient Physicians, Ventura, CA, USACommunity Memorial Hospital, Department of Pathology, Ventura, CA, USACommunity Memorial Hospital, Department of General Surgery, Ventura, CA, USAHyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an underrecognized adverse effect of a phosphate binder, sevelamer carbonate, inducing colitis in a 47-year-old male with insulin-dependent diabetes complicated by end-stage renal disease. He presented for recurrent abdominal pain with associated nausea and was found to have multiple circumferential lesions on computed tomography including distal ascending, transverse, and proximal descending colon. Colonoscopy demonstrated nearly obstructing lesions worrisome for colonic ischemia or inflammatory bowel disease. Pathological review of histology demonstrated ragged colonic mucosa with ulcerative debris and nonpolarizing crystalline material at the sites of ulceration, morphologically consistent with the phosphate binder, sevelamer carbonate. Sevelamer carbonate was discontinued, and the patient was transitioned to calcium carbonate with strict dietary restrictions. His symptoms improved with the cessation of sevelamer, and he was subsequently discharged home. He eventually underwent renal transplant without redevelopment of symptoms. Recognition of this underreported complication of sevelamer carbonate, phosphate binder, is of utmost importance in directing appropriate therapy with cessation of this medication in the setting of gastrointestinal complaints or more specifically enteritis and colitis. Clinicians providing care to end-stage renal patients taking either sevelamer and/or sodium polystyrene sulfonate should have increased awareness of the possible gastrointestinal side effects.http://dx.doi.org/10.1155/2020/4646732 |
| spellingShingle | T. Lai A. Frugoli B. Barrows M. Salehpour Sevelamer Carbonate Crystal-Induced Colitis Case Reports in Gastrointestinal Medicine |
| title | Sevelamer Carbonate Crystal-Induced Colitis |
| title_full | Sevelamer Carbonate Crystal-Induced Colitis |
| title_fullStr | Sevelamer Carbonate Crystal-Induced Colitis |
| title_full_unstemmed | Sevelamer Carbonate Crystal-Induced Colitis |
| title_short | Sevelamer Carbonate Crystal-Induced Colitis |
| title_sort | sevelamer carbonate crystal induced colitis |
| url | http://dx.doi.org/10.1155/2020/4646732 |
| work_keys_str_mv | AT tlai sevelamercarbonatecrystalinducedcolitis AT afrugoli sevelamercarbonatecrystalinducedcolitis AT bbarrows sevelamercarbonatecrystalinducedcolitis AT msalehpour sevelamercarbonatecrystalinducedcolitis |