Difference between revisions of "Hypophosphatemia"

(Harbor UCLA Adult Treatment Guidelines)
Line 27: Line 27:
  
 
===Harbor UCLA Adult Treatment Guidelines===
 
===Harbor UCLA Adult Treatment Guidelines===
# Serum phosphate <2 mg/dl, but >1 mg/dl AND the patient IS able to take PO
+
#Serum phosphate 1 mg/dl to 2 mg/dl  
##Minimize or eliminate all dextrose-containing IV solutions
+
##Able to take PO
##Aggressively treat acidosis
+
###Minimize or eliminate all dextrose-containing IV solutions
##1 tab K-phos neutral 250mg Q hour x 5 doses
+
###Aggressively treat acidosis
###Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
+
###1 tab K-phos neutral 250mg Q hour x 5 doses
##Recheck serum phosphate after last dose, and repeat dosing if continues to be <2 mg/dl
+
####Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
#Serum phosphate <2 mg/dl, but >1 mg/dl BUT the patient is NOT able to take PO
+
###Recheck serum phosphate after last dose, and repeat dosing if continues to be <2 mg/dl
##Minimize or eliminate all dextrose-containing IV solutions
+
##NOT able to take PO
##Aggressively treat acidosis
+
###Minimize or eliminate all dextrose-containing IV solutions
##Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
+
###Aggressively treat acidosis
###Peripheral administration may cause burning at injection site
+
###Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
###Consider central venous administration, if available
+
####Peripheral administration may cause burning at injection site
###Repeat dosing regimen if serum phosphate remains <2 mg/dl
+
####Consider central venous administration, if available
 +
####Repeat dosing regimen if serum phosphate remains <2 mg/dl
 
#Serum phosphate <1 mg/dl
 
#Serum phosphate <1 mg/dl
 
##Minimize or eliminate all dextrose-containing IV solutions
 
##Minimize or eliminate all dextrose-containing IV solutions

Revision as of 07:38, 18 December 2013

Background

  • 2.5-2.8 Mild
  • 1.0-2.5 Mod
  • <1.0 Severe

Diagnosis

Treatment

  1. Mild-mod
    1. KPhos /neutra phos PO
  2. Severe
    1. KPhos 2.5-5 mg/kg IV over 6hr


  • If <2.4:
    • Neutra-Phos 2 packets PO Q6hr x 48hr OR sodium phosphate 30mmol IV
  • If <1:
    • IV Sodium Phosphate 45mmol should be used


Harbor UCLA Adult Treatment Guidelines

  1. Serum phosphate 1 mg/dl to 2 mg/dl
    1. Able to take PO
      1. Minimize or eliminate all dextrose-containing IV solutions
      2. Aggressively treat acidosis
      3. 1 tab K-phos neutral 250mg Q hour x 5 doses
        1. Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
      4. Recheck serum phosphate after last dose, and repeat dosing if continues to be <2 mg/dl
    2. NOT able to take PO
      1. Minimize or eliminate all dextrose-containing IV solutions
      2. Aggressively treat acidosis
      3. Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
        1. Peripheral administration may cause burning at injection site
        2. Consider central venous administration, if available
        3. Repeat dosing regimen if serum phosphate remains <2 mg/dl
  2. Serum phosphate <1 mg/dl
    1. Minimize or eliminate all dextrose-containing IV solutions
      1. Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
    2. Aggressively treat acidosis
    3. Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
      1. Peripheral administration may cause burning at injection site
      2. Consider central venous administration, if available
    4. If patient can tolerat PO, ALSO follow steps 1 above
    5. Recheck serum phosphate after infusion
      1. Repeat IV administration if <1 mg/dl
      2. Consider oral administration if >1mg and <2 mg/dl