Uro-KP-Neutral Disease Interactions

Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.

The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.

The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.

The use of phosphates is in general contraindicated in conditions where high potassium, high phosphate, or low calcium may be encountered such as hypoparathyroidism, osteomalacia, acute pancreatitis, or chronic renal disease.

Therapy with phosphates should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Elevated serum concentrations of phosphate and calcium can exceed the solubility level and result in calcium-phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Clinical monitoring of serum calcium and phosphate concentrations is necessary.

The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.

Potassium phosphate injections contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration in patients with renal impairment. Preterm infants are particularly at risk for aluminum toxicity because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which also contain aluminum. Patients with renal impairment, including preterm infants, who receive greater than 4 to 5 mcg/kg/day of parenteral aluminum can accumulate aluminum to levels associated with central nervous system and bone toxicity. Potassium phosphate injection for parenteral nutrition is not recommended in adults weighing less than 45 kg or pediatric patients less than 12 years of age or weighing less than 40 kg due to the risks of aluminum toxicity.

Potassium phosphate injection may increase the risk of hyperkalemia. Patients with cardiac disease may be more susceptible to the effects of hyperkalemia. Caution is advised when using potassium phosphates in patients with heart disease. Continuous electrocardiographic (ECG) monitoring is recommended for higher infusion rates of potassium.

Intravenous infusion of phosphate has been reported to cause a decrease in serum magnesium (and calcium) concentrations when administered to patients with hypercalcemia and diabetic ketoacidosis. Monitor serum magnesium concentrations during treatment. Caution is advised in patients with magnesium imbalances.