Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?
A. To relieve the pain of gastric hyperacidity.
B. To prevent Curling’s stress ulcers.
C. To bind phosphorus in the intestine.
D. To reverse metabolic acidosis.
Correct Answer: C. To bind phosphorus in the intestine.
A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion.
Option A: Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Aluminum hydroxide can also serve as a phosphate binder in patients with chronic renal disease. However, its use in this manner is infrequent due to the risk of adverse effects.
Option B: Antacids will not prevent Curling’s stress ulcers. Aluminum hydroxide [Al(OH)3] dissociates into Al3+ and OH- in the stomach. The freed hydroxide groups then bind to free protons, ultimately producing water and insoluble aluminum salts, mostly Al(Cl)3, within the stomach. The proton binding serves to increase the overall pH of the stomach, i.e., less acidic, reducing the symptoms of indigestion.
Option D: Antacids will not affect metabolic acidosis. Prolonged administration should not be considered in a patient with renal impairment or a patient on dialysis, as impaired clearance of excess aluminum may precipitate the drug’s adverse effects.
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