Medicines and electrolyte disturbances

Some medicines may cause electrolyte disturbances in people with kidney disease – seek to identify the underlying cause of electrolyte disturbance and correct it.1

Sodium phosphate laxatives/preparations

Sodium phosphate laxatives/preparations are contraindicated in people with kidney disease.

There is an increased risk of kidney damage (including acute kidney failure), dehydration and electrolyte disturbance in children and adults > 55 years, dehydrated patients and patients taking diuretics, angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARBs) and NSAIDs.2

Significant changes in serum electrolyte levels occur after sodium phosphate colon preparation in patients with normal serum creatinine levels.3 It has been shown to exacerbate pre-existing hypocalcaemia or hypokalaemia in patients with apparently normal kidney function.3 They cause hyperphosphataemia in up to 40% of healthy subjects, and have been associated with acute phosphate nephropathy.1

Magnesium or sodium salt laxatives/preparations2

Avoid use of these laxatives/preparations in patients with kidney disease as significant fluid and electrolyte disturbance may occur.

Sodium phosphate laxatives2
Diacol

Fleet Ready-to-use Enema

Fleet Phospho-Soda
Magnesium or sodium salt laxatives/preparations2

Epsom Salts

Microlette

Microlax

Picolax

PicoPrep

Combination products

Go Kit

Go Kit Plus

Prep Kit-C

 

Calcitriol

Use calcitriol with caution in patients with kidney disease, it increases the risk of hypercalcaemia, hyperphosphataemia, and nephrocalcinosis. Monitor plasma calcium and phosphate levels. Advise patients to maintain a moderate dietary calcium intake and high fluid intake. A high intake of dairy foods should be discouraged because of their high phosphate content.1

Other medicines

A number of medicines, other than ACEIs and ARBs (e.g. amiloride, eplerenone, and spironolactone) may increase the risk of hyperkalaemia when used in patients with kidney disease. Monitor kidney function and potassium levels if prescribing these medicines.2

The risk of hyperkalaemia is increased if one of these medicines is used together with an ACEI, ARB or NSAID, or in a patient with diabetes.4 Close monitoring of serum potassium and glomerular filtration rate is recommended. Spironolactone is best avoided in patients with a glomerular filtration rate < 30 mL/min.

References

  1. Endocrinology Writing Group. Therapeutic Guidelines: Endocrinology. Version 4 ed. Melbourne: Therapeutic Guidelines Ltd, 2009.
  2. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2013.
  3. Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointestinal endoscopy 1996;43:467–9.[PubMed]
  4. Faull R, Lee L. Prescribing in renal disease Australian Prescriber 2007;30:17–20. [Online]