Medizin Klinik IV, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
Correspondence and offprint requests to: Dr Martin Tepel, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Med. Klinik IV Nephrologie, Hindenburgdamm 30, D-12200 Berlin, Germany. Email: Martin.Tepel{at}charite.de
Keywords: calcium carbonate; constipation; haemodialysis
Case
A 78-year-old man presented with abdominal discomfort and constipation for several days. He had been receiving regular haemodialysis treatment for 8 months because of end-stage renal failure due to diabetic nephropathy. His medical history included a hemiplegia and a Billroth-II resection more than 20 years ago because of gastric ulcer. Among his medication were furosemide, amlodipine, insulin, erythropoietin and calcium carbonate (three tablets thrice daily). On physical examination, the patient was an alert, cooperative man, his blood pressure was 130/80 mmHg, pulse 80 beats per minute and regular and he was afebrile. The abdomen was slightly distended with reduced abdominal bruits. Laboratory studies revealed increased levels of serum creatinine and blood urea nitrogen, a normal white blood cell count, haemoglobin of 9.9 g/dl, serum calcium of 2.58 mmol/l and potassium of 3.73 mmol/l. An anterioposterior abdominal radiograph in supine position showed scattered hyperdense lesions with a diameter of 2 cm in the left upper and left lower quadrant (Figure 1). This distribution was accounted for by the patient's regular intake of calcium carbonate tablets. The patient's complaints disappeared completely after laxative treatment. Most haemodialysis patients are prone to constipation due to reduced fluid intake, a low-fibre diet, inactivity and uraemic polyneuropathy.
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