Antacid and sucralfate-induced hypophosphatemic osteomalacia: a case report and review of the literature.
A 42-year-old woman presented to our institution with a 2-week history of bone pain in the lower extremities. Her history was remarkable for duodenal ulcer and long-term treatment with a magnesium-aluminum hydroxide antacid (Maalox) and sucralfate. Initial laboratory studies showed severe hypophosphatemia and elevated alkaline phosphatase and serum 1,25-dihydroxyvitamin D levels. Bone scan showed multiple areas of increased uptake consistent with osteomalacia and microfractures. The patient recovered completely following withdrawal of antacids and sucralfate and short-term treatment with phosphate. Although hypophosphatemia induced by aluminum-containing antacids is rare, treatment of peptic ulcer disease with a combination of two aluminum-containing agents may increase the risk of clinically significant hypophosphatemia. Awareness of this condition is important, because early recognition can prevent morbidity and lead to safe and effective treatment.
Chines
A
A
Division of Endocrinology and Metabolism, Jewish Hospital of St. Louis, Missouri 63110.
Pacifici
R
R
D000328:Adult; D000536:Aluminum Hydroxide / Q000009:adverse effects*; D000863:Antacids / Q000009:adverse effects; D004338:Drug Combinations; D004381:Duodenal Ulcer / Q000188:drug therapy; D005260:Female; D006801:Humans; D008276:Magnesium Hydroxide / Q000009:adverse effects*; D010018:Osteomalacia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D010710:Phosphates / Q000097:blood* / Q000627:therapeutic use; D013392:Sucralfate / Q000009:adverse effects*
D000863:Antacids; D004338:Drug Combinations; D010710:Phosphates; C013591:aluminum hydroxide, magnesium hydroxide, drug combination; D013392:Sucralfate; D000536:Aluminum Hydroxide; D008276:Magnesium Hydroxide