Difference between revisions of "Hypophosphatemia"

(Causes of Hypophosphatemia)
(Harbor UCLA Adult Treatment Guidelines)
Line 46: Line 46:
  
 
===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
 
***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 <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
 
***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 <2 mg/dl
**Recheck serum phosphate after infusion
+
 
***Repeat IV administration if <1 mg/dl
+
'''Serum phosphate <1 mg/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 <1 mg/dl
 +
**Consider oral administration if >1mg and <2 mg/dl
  
 
==See Also==
 
==See Also==

Revision as of 13:38, 26 August 2015

Background

Clinical Features

Differential Diagnosis

Causes of Hypophosphatemia

  • Internal redistribution
  • Decreased intestinal absorption
    • Inadequate intake
    • Antacids containing aluminum or magnesium
    • Steatorrhea and/or chronic diarrhea
  • Increased urinary excretion
  • Renal replacement therapy (dialysis)

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 tolerate 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