# CKD 환자가 calcium acetate로 고칼슘혈증 발생. 예상되는 처방은?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391826&lang=ko  
> language: ko  
> subject: Medical Emergencies  
> category: PA

## 문제

CKD 환자가 calcium acetate로 고칼슘혈증 발생. 예상되는 처방은?

## 보기

1. IV calcium gluconate 추가
2. 식이 칼슘 증가
3. Calcium acetate 용량 증량
4. 비-칼슘 인산 결합제(sevelamer·lanthanum·ferric citrate)로 전환 **✔ 정답**

**정답: 4**

## 해설

정답 (2): 칼슘 함유 결합제(acetate/carbonate)는 CKD에서 고칼슘혈증·혈관 석회화 유발 가능. Ca 상승 시 비-칼슘 결합제(sevelamer·lanthanum·ferric citrate·sucroferric oxyhydroxide)로 전환. (1,3,4) 악화.

## 심화 해설

Memory Tip 칼슘 결합제 = "저가지만 칼슘 부담". Ca 상승·혈관 석회화 시 sevelamer/lanthanum 전환.

## 임상 시나리오

시나리오 70세 여성 CKD로 calcium acetate 인산 결합제. 새 Ca 11.5·변비. PTH 안정.

## 핵심 개념

- **Calcium acetate/carbonate** — 저가 인산 결합제; 고칼슘혈증·혈관 석회화 위험.
- **CKD 고칼슘혈증** — 결합제·비타민 D 유사체에 의한 약물 유발; 비-칼슘 결합제로 전환.
- **혈관 석회화** — CKD-MBD의 심혈관 합병증; 비-칼슘 결합제로 감소.

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