Mrs Joaquin Case Study
13. Mrs. Joaquin has a PO4 restriction. Why? What foods have the highest levels of phosphorus? Normal working kidneys can "remove extra phosphorus in the blood." When a patient has CKD, the kidneys have a hard time removing extra phosphorus. High phosphorus levels are harmful to the body and can damage to the body. For example, extra phosphorus causes "body changes that pull calcium out of the bones--which can make them weak and cause breaks and fractures. A safe level on phosphorus in the blood ranges from 2.5 to 4.5 mg/dL.
Foods that have the highest levels of phosphorus: Beverages
1. beer
2. chocolate drinks
3. cocoa
4. dark sodas
5. drinks made with milk
6. canned iced teas
Dairy Products:
1. cheese
2. milk
3. cream soups
4. ice cream
5. yogurt
6. pudding
7. custard
8. liquid nondairy creamer
Protein:
1. oysters
2. beef liver
3. fish roe
4. sardines
5. chicken liver
6. organ meat
Other:
1. chocolate candy
2. most canned/ processed foods
3. caramels
4. pizza
5. oat bran muffin
6. brewer's yeast
(Phosphorus and Your CKD Diet, 2017)
14. Mrs. Joaquin tells you that one of her friends can drink only certain amounts of liquids and wants to know if that is the case of her. What foods are considered to be fluids? What recommendations can you make for Mrs. Joaquin?
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Mrs. Joaquin's GFR is 28 mL /min; therefore her GFR is a good bit lower than the normal rate, 125 mL/min. As GFR falls, "the increased activity by the remaining nephrons is often sufficient to maintain electrolyte excretion." Therefore, Mrs. Joaquin is more than likely in the third or fourth stage of CKD, considering she is not far from the extremely low limit ( less than 5 mL per min). This is when electrolyte imbalances are very likely (Rolfes, Pinna & Whitney, 2012,
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