碳酸镧是非铝、非钙的含金属磷结合剂，用于治疗CKD患者的高磷血症[1]。目前已有多项临床报告证实可在肠道中检测到镧的存在[2,3]。服用碳酸镧常见的副反应包括恶心、腹泻、低血压、腹痛及便秘[1,4]。但多个临床报告及研究发现，碳酸镧不仅可导致意识错乱等不良反应，甚至可在体内产生蓄积[2,5,6]。2009年西班牙R. Ramos Sánchez等学者在Nefrología上发表了一篇关于患者服用碳酸镧出现高淀粉酶血症及由于支气管吸入碳酸镧死亡的病例[7]。
患者为54岁女性，因低血压引起的腹泻及直肠出血入院治疗。腹部X光片显示结肠处呈弥漫性浑浊（图1）。这与患者入院前口服碳酸镧（0.75g t.i.d）治疗高磷血症2个月的事实吻合。之后进行的腹部CT检查显示直肠乙状结肠连接处存在结节，胰腺或腹部其它部位无病理性肿块。当天患者突现呼吸困难且病情恶化，伴有低血压及氧饱和度下降。胸部X光片显示沿肺泡出现不透射线的条纹（图2）。家属代诉患者入院前已停用碳酸镧。患者进行血液透析后呼吸道状况无明显改善，最终死亡。
图1：腹部X光片。图像显示结肠处不透射线影像，为碳酸镧。
图2：胸部X光片。图像显示肺泡中有不透射线的条纹。
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