Help with high phosphorus labs

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Anyone have a magic remedy or idea on how to get patient's phosphorus levels lower?

Labs were just OK when lab draw was Wed/Thursday we were keeping our head just above water. We are now drawing labs on Monday's and Tuesday's, d/t lab being overwhelmed on Wed/Thursdays with so many labs coming in, which as you guessed it, the labs are considerably worse over the weekend and all.

Well, now we have to educate (keep at these patients) (each treatment) in different ways to get them to get their phosphorus down. We also have to document what we did, how we approached these pt and so on. More than half of our pts. state they feel as if they are being harassed.

We have given articles/recipes/menu/shopping lists, good/bad list of foods.

Thanks in advance

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Specializes in Nephrology, Cardiology, ER, ICU.

At some point the pt has to take responsibility.

Some things I've done

Change binders to reveal powder where you can sometimes get away with once a day dosing

Change to fosrenol chewables. Some pts like them better

I am pretty graphic with calciphylaxis pics too

I try to engage the pt to buy into this idea that if they want to feel better they need to have a part in this

I keep a close eye on PTH too and this also helps with phosphorous control

If they need a parathyroidectomy I get them referred for that too.

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Thanks TramaRUs,

We too have those nasty pictures, and have shown the patients.

PTH is also monitored closely.

Thanks for the advice on fosrenol chewables and reveal powder I'll look into those.

It just seems as if the more we badger, the more the patients rebel. We also have to sign off and ask if the patient is taking his/her binders every treatment.

We also remind the patients, and post the dates, of the next lab draw.

I just hope it doesn't go so far as to have to call these patients at home, I think I'll draw the line on that. I did hear that someone from this company did call one of the patients at home, let me tell you, it didn't go over so well.

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Hi TramaRUs,

Just was looking up the powder form that you suggested, but was unable to find info on this.

Was this a Renvela powder or something different?

Please give me some info on the 1x/day dosing as this would be great for some of the patients that can't stand and forget

to take all the pills they need to take to get their phosphorus level down.

Thanks again

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Specializes in Nephrology, Cardiology, ER, ICU.

it's called renvela powder. pts mix it with about 2 ozs of water or juice (my pts report cranapple is the best) and then either take it first thing in the morning or with biggest meal of the day. it coats the stomach lining and forms a jelly substance that then absorbs the phosphorous. I have pts that take up to three packets per day. it's really portable too.

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Specializes in Nephrology.

Great suggestions trauma. I just wanted to add another thing that we do at our facility. We make a competition out of it! MWF against TTS or 1st shift against 2nd shift. We keep a scoreboard near the entrance of the unit and the team with the highest points at the end of the competition gets a prize. The patients begin to harp on each other and they motivate each other. I have often hear my patients asking their "teammates" if they have their binders with them and if they are watching what they eat.

The last competition we had was "phosphorus football". The winning team got a visit from the local NFL team's cheerleaders and were allowed to take a photo with them if they wanted to. The cheerleaders came for free as they have to do a certian amount of free appearances each year and they were really great with the patients. They were telling them how great it was that they were able to win by keeping their phosphorus in check.

Games and competitions are a great motivator!

We also do phosphorus bingo on cards that we made ourselves!

Good luck!

Sorry for any spelling errors....I can't get the stupid spell check to work for me....ever!

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Specializes in Nephrology.

Oh and for those young guys who think they are invincible...I let them know that chronic high phosporus levels can have a really bad effect on their "equipment"...:eek: This usually gets them in line for at least a little while....

Combine this with the pics of calcifylaxis and you've got a knock out punch!

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Nocturnal Dialysis :)

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