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Ingestion of Lanthanum Carbonate Tablets

      A 55-year-old man with end-stage renal disease secondary to diabetic nephropathy was found unresponsive and apneic. Earlier that day, he had complained of diffuse burning abdominal pain to his wife. Paramedics arrived on scene to find the patient in pulseless electrical activity; cardiopulmonary resuscitation was initiated. The patient was brought to the emergency department and successfully resuscitated. Admission laboratory test results included potassium level of 6.3 mg/dL; calcium level of 7.9 mg/dL; and phosphorus level of 6.8 mg/dL. Abdominal radiography revealed 18 radio-opaque disc-like objects located throughout the gastrointestinal tract (Fig 1). After being notified of these objects, the patient's family members suggested that the patient had been taking a tablet formulation of lanthanum carbonate that he mistakenly was swallowing instead of chewing. The family members brought in his tablets, which matched the appearance of the tablets extracted from the patient's stool. Lanthanum carbonate is a calcium-free metal-based phosphate-binding agent commonly used to treat hyperphosphatemia in patients with end-stage renal disease. All patients taking lanthanum carbonate should be counseled to chew the tablets completely before swallowing.
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      Figure 1Radiograph shows lanthanum carbonate tablets throughout the gastrointestinal tract.
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