The nurse would question an order for which type of antacid in patients with chronic renal failure?
A. Aluminum-containing antacids
B. Calcium-containing antacids
C. Magnesium-containing antacids
D. All of the above.
Correct Answer: C. Magnesium-containing antacids
Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Antacids that contain magnesium have a laxative effect that may cause diarrhea, and in patients with renal failure, they may cause increased magnesium levels in the blood, because of the reduced ability of the kidneys to eliminate magnesium from the body in the urine.
Option A: Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. With the recognition that long-term ingestion of large doses of phosphate-binding antacids containing aluminum can result in aluminum retention and toxicity, the use of phosphate-binding agents free of this element, such as calcium carbonate, has been recommended for patients with chronic renal failure.
Option B: Calcium-containing antacids are also appropriate because these patients may be hypocalcemic. Calcium salts neutralize gastric acidity resulting in increased gastric and duodenal bulb pH; they additionally inhibit the proteolytic activity of pepsin if the pH is greater than 4 and increase lower esophageal sphincter tone. The calcium released from calcium carbonate is known to increase peristalsis in the esophagus, pushing the acid into the stomach and providing relief from symptoms of heartburn.
Option D: The average therapeutic dose of antacid is 10 to 15 mL (1 tablespoon or one package content) of liquid or 1 to 2 tablets 3 to 4 times a day. Periodic monitoring of calcium and phosphorus plasma concentrations is a suggested practice in patients on chronic therapy.
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