From the Research
Hyperphosphatemia in a 71-year-old male with alcohol use disorder is likely caused by acute or chronic kidney disease, which impairs phosphate excretion, as alcoholism can lead to kidney damage over time, and other potential causes such as rhabdomyolysis, alcoholic ketoacidosis, and vitamin D toxicity should also be considered. The most common causes of hyperphosphatemia include:
- Acute or chronic kidney disease, which impairs phosphate excretion, as alcoholism can lead to kidney damage over time 1, 2, 3
- Rhabdomyolysis, a potential complication of alcohol withdrawal or prolonged immobility during intoxication, releases phosphate from damaged muscle cells
- Alcoholic ketoacidosis can cause transcellular phosphate shifts
- Vitamin D toxicity from supplements could increase intestinal phosphate absorption
- Tumor lysis syndrome should be considered if the patient has underlying malignancy
- Medications like phosphate-containing laxatives or enemas can contribute to elevated phosphate levels
Management of hyperphosphatemia includes:
- Treating the underlying cause
- Restricting dietary phosphate intake to 800-1000 mg/day
- Administering phosphate binders like calcium acetate (667 mg with meals), sevelamer (800-1600 mg with meals), or lanthanum carbonate (500-1000 mg with meals), with consideration of the potential risks and benefits of each, including the rare but serious risk of intestinal obstruction associated with lanthanum carbonate 4
- Hemodialysis may be necessary in severe cases with renal failure
- Correcting other electrolyte abnormalities and addressing the alcohol use disorder through appropriate rehabilitation programs are essential components of comprehensive treatment 1, 2, 3, 5