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MSK: Orders for the CRF Patient

- See: Bone Disease associated with Renal Disease:
- Discussion:
    - serum Phos is kept between 4 to 5 mg/dl w/ phos binders w/ meals;
    - diet should be supplemented with PO Calcium (1.0 to 1.5 gm/day);
    - if PO calcium does not bring the serum calcium to a level that will supress PTH, then add 1,25 (OH)2 D3 should be added to diet;
          - starting dose is 0.25 ug/day, with weekly increases in dose until a decr is seen in serum Alk Phos activity (marker of PTH activity on bone);
    - if PTH activity cannot be suppressed by raising the serum Ca level to the upper range of normal (10.0 to 10.5 mg/dl) then subtotal parathyroidectomy should be considered