Uncrushed residual tablets of Lanthanum carbonate in the intestine

Abstract

To treat hyperphosphatemia, calcium carbonate and sevelamer hydrochloride are conventionally prescribed, and lanthanum carbonate is a newly developed phosphate binder that does not contain calcium and shows strong phosphate adsorption. Although only a slight amount of lanthanum is absorbed, the safety of lanthanum long-term administration is not clear because of its deposition in several tissues. Here we report a chronic hemodialysis patient treated with lanthanum carbonate, who died of ischemic colitis and hypertrophic cardiomyopathy. A 52-year-old male undergoing regular hemodialysis at another dialysis center was admitted to our hospital for evaluation of lower abdominal pain. He had begun to take lanthanum carbonate (chewable tablet) 1 month before admission. Abdominal X-ray image showed 4 round lesions that appeared to be foreign objects such as metal or mineral in the bowel. The patient developed cardiopulmonary arrest with a bloody bowel discharge and died despite efforts of resuscitate. Autopsy findings demonstrated extensive intestinal ischemia but no ulceration of the mucosa and no perforations. Lanthanum carbonate tablets remaining in the intestine retained their original forms with the carved seals on the surface because there was no elution in the intestine. These remaining tablets could not be associated with intestinal disorder. The efficacy of phosphate adsorption, however, could not be exerted. It is necessary to educate patients undergoing hemodialysis about the appropriate administration of this tablet.