Difference between revisions of "Hypophosphatemia"

(Differential Diagnosis)
(Differential Diagnosis)
 
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==Background==
 
==Background==
 +
*Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets)
  
 
==Clinical Features==
 
==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 14:
 
===Causes of Hypophosphatemia===
 
===Causes of Hypophosphatemia===
 
*Internal redistribution
 
*Internal redistribution
**Refeeding of malnourished
+
**[[refeeding syndrome|Refeeding of malnourished]]
 
**[[DKA]]
 
**[[DKA]]
 
**[[Nonketotic hyperglycemia]]
 
**[[Nonketotic hyperglycemia]]
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**[[Fanconi syndrome]]  
 
**[[Fanconi syndrome]]  
 
***[[Multiple myeloma]]
 
***[[Multiple myeloma]]
**Osmotic diuresis (most often due to glucosuria)
+
**Osmotic diuresis (most often due to [[hyperglycemia|glucosuria]])
**Proximally acting diuretics (e.g. [[acetazolamide]] and some [[thiazide diuretics]])
+
**Proximally acting [[diuretics]] (e.g. [[acetazolamide]] and some [[thiazide diuretics]])
 
**Acute volume expansion
 
**Acute volume expansion
**Intravenous iron administration  
+
**Intravenous [[iron supplementation|iron administration]]
*Renal replacement therapy
+
*Renal replacement therapy ([[dialysis complications|dialysis]])
  
==Diagnosis==
+
==Evaluation==
 
*2.5-2.8 Mild
 
*2.5-2.8 Mild
*1.0-2.5 Mod
+
*1.0-2.5 Moderate
 
*<1.0 Severe
 
*<1.0 Severe
  
==Treatment ==
+
==Management==
*Mild-mod
+
*Mild-moderate
 
**KPhos /neutra phos PO
 
**KPhos /neutra phos PO
 
*Severe
 
*Severe
**KPhos 2.5-5 mg/kg IV over 6hr
+
**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
 
***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 <2 mg/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 <2 mg/dl
 
*'''Serum phosphate <1 mg/dl'''
 
 
**Minimize or eliminate all dextrose-containing IV solutions
 
**Minimize or eliminate all dextrose-containing IV solutions
***Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
 
 
**Aggressively treat acidosis
 
**Aggressively treat acidosis
**Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
+
**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
 
***Peripheral administration may cause burning at injection site
 
***Consider central venous administration, if available
 
***Consider central venous administration, if available
**If patient can tolerat PO, ALSO follow steps 1 above
+
***Repeat dosing regimen if serum phosphate remains <2mg/dl
**Recheck serum phosphate after infusion
+
 
***Repeat IV administration if <1 mg/dl
+
'''Serum phosphate <1mg/dl'''
***Consider oral administration if >1mg and <2 mg/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==
 
==See Also==

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