Difference between revisions of "Hypophosphatemia"

(Harbor UCLA Adult Treatment Guidelines)
Line 1: Line 1:
 
==Background==
 
==Background==
*2.5-2.8 Mild
 
*1.0-2.5 Mod
 
*<1.0 Severe
 
  
==Diagnosis==
+
==Clinical Features==
 
*CNS
 
*CNS
 
**[[Weakness]]
 
**[[Weakness]]
Line 12: Line 9:
 
*Cardiac
 
*Cardiac
 
**Impaired myocardial function
 
**Impaired myocardial function
 +
 +
==Differential Diagnosis==
 +
 +
==Diagnosis==
 +
*2.5-2.8 Mild
 +
*1.0-2.5 Mod
 +
*<1.0 Severe
  
 
==Treatment ==
 
==Treatment ==
#Mild-mod
+
*Mild-mod
##KPhos /neutra phos PO
+
**KPhos /neutra phos PO
#Severe
+
*Severe
##KPhos 2.5-5 mg/kg IV over 6hr
+
**KPhos 2.5-5 mg/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 1 mg/dl to 2 mg/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 <2 mg/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 <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
###Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
+
***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)
+
**Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of 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
+
**If patient can tolerat PO, ALSO follow steps 1 above
##Recheck serum phosphate after infusion
+
**Recheck serum phosphate after infusion
###Repeat IV administration if <1 mg/dl
+
***Repeat IV administration if <1 mg/dl
###Consider oral administration if >1mg and <2 mg/dl
+
***Consider oral administration if >1mg and <2 mg/dl
  
 
==See Also==
 
==See Also==

Revision as of 12:34, 18 July 2015

Background

Clinical Features

Differential Diagnosis

Diagnosis

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

Treatment

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

Harbor UCLA Adult Treatment Guidelines

  • Serum phosphate 1 mg/dl to 2 mg/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 <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
      • 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 tolerat PO, ALSO follow steps 1 above
    • Recheck serum phosphate after infusion
      • Repeat IV administration if <1 mg/dl
      • Consider oral administration if >1mg and <2 mg/dl

See Also