The client with chronic renal failure is at risk of developing dementia-related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?
A. aluminum hydroxide (Alu-cap)
B. calcium carbonate (Tums)
C. aluminum hydroxide (Amphojel)
D. aluminum hydroxide (Basaljel)
Correct Answer: B. calcium carbonate (Tums)
Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. These products are made from aluminum hydroxide. Tums are made from calcium carbonate and also bind phosphorus. Tums are prescribed to avoid the occurrence of dementia-related to a high intake of aluminum. Phosphate binding agents are needed by the client in renal failure because the kidneys cannot eliminate phosphorus.
Option A: 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 C: Aluminum hydroxide is often administered orally for the temporary relief of heartburn or gastroesophageal reflux. It may be used topically, temporarily, to protect and relieve chafed and abraded skin, minor wounds and burns, and skin irritations resulting from friction and rubbing.
Option D: Aluminum exists at a steady state within the body, so the body manages transient increases in aluminum uptake from use as an antacid with an equivalent increase in urinary excretion of unmodified aluminum. However, the setpoint of that steady-state may become elevated with prolonged increased intake of aluminum, so aluminum hydroxide treatment should not be considered as a long-term solution for patients suffering from acid indigestion.
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