Hypophosphatemia: Difference between revisions
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==Background== | ==Background== | ||
* | *Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets) | ||
== | ==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 11: | ||
**Impaired myocardial function | **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 | ||
**IV | **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)]] | |||
[[Category:FEN]] | [[Category:FEN]] | ||
Latest revision as of 16:48, 16 October 2019
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)
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