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A patient with severe hyperphosphataemia
  1. K M Chow,
  2. P K T Li
  1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
  1. Dr Philip K T Li, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong philipli{at}cuhk.edu.hk

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Answers on p 483.

A 67 year old Chinese woman presented to her general practitioner with abdominal pain. She had an unremarkable history except for bronchiectasis diagnosed a decade before. Colonoscopy was arranged in view of positive faecal occult blood. Preliminary investigation revealed underlying renal insufficiency with a serum creatinine concentration of 700 μmol/l (table 1). There was no abnormality except several small tubular adenomatous polyps in the colon.

Table 1

Biochemical investigations

She developed symptomatic hypocalcaemia shortly after colonoscopy, and subsequent investigation revealed significant hyperphosphataemia, as shown in table 1. Further evaluation confirmed chronic renal failure secondary to polycystic kidney disease.

Questions

(1)
What is the cause of the hyperphosphataemia?
(2)
What action would you take?
(3)
How should this be avoided?

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