View source for Hypophosphatemia

==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 syndrome|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]] 
***[[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===
'''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==
*[[Electrolyte Abnormalities (Main)]]

==References==
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[[Category:FEN]]