Phosphate Franklin — Phosphorus Imbalance: The Calcium See-Saw & Binders With Meals
His phosphorus climbs, his calcium falls, and he itches everywhere — the binder only works if he takes it with food
Franklin scratches his arms raw between dialysis sessions. His phosphorus is 7.2, his calcium is low, and he has been taking his binder at bedtime.
Franklin has chronic kidney disease, so he cannot excrete phosphorus and his level rises. Phosphorus and calcium move on a see-saw: as phosphorus climbs, calcium falls, producing muscle cramps, tingling, tetany and positive Chvostek and Trousseau signs, along with relentless itching from calcium-phosphate deposits in the skin. Phosphate binders must be taken with meals to bind dietary phosphorus in the gut; taken between meals they do nothing. The opposite problem, hypophosphatemia, appears in refeeding syndrome and alcohol use disorder and causes muscle weakness and respiratory difficulty.
Read Phosphate Franklin's full story →The story arc
The setup
Franklin's kidneys can no longer clear phosphorus, and his diet is full of dairy, processed meat and cola.
The turn
His phosphorus rises to 7.2, his calcium drops, and he develops tingling around his mouth and muscle cramps.
The crisis
He itches constantly and his skin is excoriated from scratching.
The save
The nurse discovers Franklin takes his binder at bedtime and teaches him to take it with every meal and snack, along with dietary limits and dialysis adherence.
NCLEX study section — Phosphorus Imbalance: The Calcium See-Saw & Binders With Meals
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.