Do not Crush Sevelamer Hydrochloride (Renagel) to Place Down a Nasogastric or Feeding Tube



Do not Crush Sevelamer Hydrochloride (Renagel) to Place Down a Nasogastric or Feeding Tube


Ashita Goel MD



Hyperphosphatemia is a common metabolic derangement seen in end-stage renal disease secondary to the inability of the kidney to excrete serum phosphate. High levels of phosphates can result in secondary hyperparathyroidism and release of calcium from bone. This loss of calcium from bone can result in osteodystrophy and ectopic calcium deposition into soft tissues including deposits in coronary or cerebral arteries.


What not to Do

Sevelamer (Renagel) is an aluminum- and calcium-free phosphate binder used in the treatment of hyperphosphatemia in end-stage renal disease. Sevelamer is a cationic polymer (poly[allylamine hydrochloride]) cross-linked with epichlorohydrin, which binds phosphate anions by ion exchange and hydrogen binding. Although sevelamer is hydrophilic, it is not absorbed by the gastrointestinal tract. When the polymer comes in contact with gastric or intestinal fluid, it expands through hydration; it can expand up to eight times its weight. This gelatinous form binds phosphate in the gastrointestinal tract and then is excreted in feces. This polymer cannot be crushed or broken prior to ingestion because an intact gelatinous matrix is needed for efficient phosphate binding.

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Do not Crush Sevelamer Hydrochloride (Renagel) to Place Down a Nasogastric or Feeding Tube

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