Difference between revisions of "Hypophosphatemia"

(Treatment)
(Differential Diagnosis)
 
(19 intermediate revisions by 4 users not shown)
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==Background==
 
==Background==
*2.5-2.8 Mild
+
*Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets)
*1.0-2.5 Mod
 
*<1.0 Severe
 
  
==Diagnosis==
+
==Clinical Features==
 
*CNS
 
*CNS
 
**[[Weakness]]
 
**[[Weakness]]
**Circumoral and fingertip paresthesias
+
**Circumoral and fingertip [[paresthesias]]
 
**Decreased DTRs
 
**Decreased DTRs
 
**[[Decreased Mental Status]]
 
**[[Decreased Mental Status]]
Line 13: Line 11:
 
**Impaired myocardial function
 
**Impaired myocardial function
  
==Treatment ==
+
==Differential Diagnosis==
#Mild-mod
+
===Causes of Hypophosphatemia===
##KPhos /neutra phos PO
+
*Internal redistribution
#Severe
+
**[[refeeding syndrome|Refeeding of malnourished]]
##KPhos 2.5-5 mg/kg IV over 6hr
+
**[[DKA]]
 +
**[[Nonketotic hyperglycemia]]
 +
**Receiving hyperalimentation
 +
**Acute [[respiratory alkalosis]]
 +
**Hungry bone syndrome
 +
*Decreased intestinal absorption
 +
**Inadequate intake
 +
**Antacids containing aluminum or magnesium
 +
**Steatorrhea and/or chronic [[diarrhea]]
 +
*Increased urinary excretion
 +
**Vitamin D deficiency or resistance
 +
**Primary renal phosphate wasting (rare genetic disorders)
 +
**[[Fanconi syndrome]]
 +
***[[Multiple myeloma]]
 +
**Osmotic diuresis (most often due to [[hyperglycemia|glucosuria]])
 +
**Proximally acting [[diuretics]] (e.g. [[acetazolamide]] and some [[thiazide diuretics]])
 +
**Acute volume expansion
 +
**Intravenous [[iron supplementation|iron administration]]
 +
*Renal replacement therapy ([[dialysis complications|dialysis]])
 +
 
 +
==Evaluation==
 +
*2.5-2.8 Mild
 +
*1.0-2.5 Moderate
 +
*<1.0 Severe
 +
 
 +
==Management==
 +
*Mild-moderate
 +
**KPhos /neutra phos PO
 +
*Severe
 +
**KPhos 2.5-5mg/kg IV over 6hr
  
 
===Harbor UCLA Adult Treatment Guidelines===
 
===Harbor UCLA Adult Treatment Guidelines===
#Serum phosphate 1 mg/dl to 2 mg/dl  
+
'''Serum phosphate 1mg/dl to 2mg/dl'''
##Able to take PO
+
*Able to take PO
###Minimize or eliminate all dextrose-containing IV solutions
+
**Minimize or eliminate all dextrose-containing IV solutions
###Aggressively treat acidosis
+
**Aggressively treat acidosis
###1 tab K-phos neutral 250mg Q hour x 5 doses
+
**1 tab K-phos neutral 250mg Q hour x 5 doses
####Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
+
***Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
###Recheck serum phosphate after last dose, and repeat dosing if continues to be <2 mg/dl
+
**Recheck serum phosphate after last dose, and repeat dosing if continues to be <2mg/dl
##NOT able to take PO
+
*NOT able to take PO
###Minimize or eliminate all dextrose-containing IV solutions
+
**Minimize or eliminate all dextrose-containing IV solutions
###Aggressively treat acidosis
+
**Aggressively treat [[acidosis]]
###Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
+
**Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
####Peripheral administration may cause burning at injection site
+
***Peripheral administration may cause burning at injection site
####Consider central venous administration, if available
+
***Consider central venous administration, if available
####Repeat dosing regimen if serum phosphate remains <2 mg/dl
+
***Repeat dosing regimen if serum phosphate remains <2mg/dl
#Serum phosphate <1 mg/dl
+
 
##Minimize or eliminate all dextrose-containing IV solutions
+
'''Serum phosphate <1mg/dl'''
###Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
+
*Minimize or eliminate all [[dextrose]]-containing IV solutions
##Aggressively treat acidosis
+
**Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
##Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
+
*Aggressively treat [[acidosis]]
###Peripheral administration may cause burning at injection site
+
*Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
###Consider central venous administration, if available
+
**Peripheral administration may cause burning at injection site
##If patient can tolerat PO, ALSO follow steps 1 above
+
**Consider central venous administration, if available
##Recheck serum phosphate after infusion
+
*If patient can tolerate PO, ALSO follow steps 1 above
###Repeat IV administration if <1 mg/dl
+
*Recheck serum phosphate after infusion
###Consider oral administration if >1mg and <2 mg/dl
+
**Repeat IV administration if <1mg/dl
 +
**Consider oral administration if >1mg and <2mg/dl
 +
 
 +
==Disposition==
  
[[Category:FEN]]
+
==See Also==
 +
*[[Electrolyte Abnormalities (Main)]]
  
 
[[Category:FEN]]
 
[[Category:FEN]]

Latest revision as of 16:48, 16 October 2019

Background

  • Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets)

Clinical Features

Differential Diagnosis

Causes of Hypophosphatemia

Evaluation

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

Management

  • Mild-moderate
    • KPhos /neutra phos PO
  • Severe
    • KPhos 2.5-5mg/kg IV over 6hr

Harbor UCLA Adult Treatment Guidelines

Serum phosphate 1mg/dl to 2mg/dl

  • Able to take PO
    • Minimize or eliminate all dextrose-containing IV solutions
    • Aggressively treat acidosis
    • 1 tab K-phos neutral 250mg Q hour x 5 doses
      • Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
    • Recheck serum phosphate after last dose, and repeat dosing if continues to be <2mg/dl
  • NOT able to take PO
    • Minimize or eliminate all dextrose-containing IV solutions
    • Aggressively treat acidosis
    • Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
      • Peripheral administration may cause burning at injection site
      • Consider central venous administration, if available
      • Repeat dosing regimen if serum phosphate remains <2mg/dl

Serum phosphate <1mg/dl

  • Minimize or eliminate all dextrose-containing IV solutions
    • Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
  • Aggressively treat acidosis
  • Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
    • Peripheral administration may cause burning at injection site
    • Consider central venous administration, if available
  • If patient can tolerate PO, ALSO follow steps 1 above
  • Recheck serum phosphate after infusion
    • Repeat IV administration if <1mg/dl
    • Consider oral administration if >1mg and <2mg/dl

Disposition

See Also