Hypophosphatemia: Difference between revisions
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===Harbor UCLA Adult Treatment Guidelines=== | ===Harbor UCLA Adult Treatment Guidelines=== | ||
'''Serum phosphate | '''Serum phosphate 1mg/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 | ||
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***Repeat dosing regimen if serum phosphate remains <2 mg/dl | ***Repeat dosing regimen if serum phosphate remains <2 mg/dl | ||
'''Serum phosphate < | '''Serum phosphate <1mg/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 | ||
Line 71: | Line 71: | ||
*If patient can tolerate PO, ALSO follow steps 1 above | *If patient can tolerate PO, ALSO follow steps 1 above | ||
*Recheck serum phosphate after infusion | *Recheck serum phosphate after infusion | ||
**Repeat IV administration if < | **Repeat IV administration if <1mg/dl | ||
**Consider oral administration if >1mg and <2 mg/dl | **Consider oral administration if >1mg and <2 mg/dl | ||
Revision as of 07:51, 19 July 2016
Background
- Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets)
Clinical Features
- CNS
- Weakness
- Circumoral and fingertip paresthesias
- Decreased DTRs
- Decreased Mental Status
- Cardiac
- Impaired myocardial function
Differential Diagnosis
Causes of Hypophosphatemia
- Internal redistribution
- Refeeding of malnourished
- 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
- Osmotic diuresis (most often due to glucosuria)
- Proximally acting diuretics (e.g. acetazolamide and some thiazide diuretics)
- Acute volume expansion
- Intravenous iron administration
- Renal replacement therapy (dialysis)
Diagnosis
- 2.5-2.8 Mild
- 1.0-2.5 Mod
- <1.0 Severe
Management
- Mild-mod
- KPhos /neutra phos PO
- Severe
- KPhos 2.5-5 mg/kg IV over 6hr
Harbor UCLA Adult Treatment Guidelines
Serum phosphate 1mg/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 <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 <2 mg/dl