Hypophosphatemia: Difference between revisions
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==Background== | ==Background== | ||
*Phosphate required in function of all hematologic cells (RBCs, WBCs, platelets) | |||
==Clinical Features== | ==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 14: | ||
===Causes of Hypophosphatemia=== | ===Causes of Hypophosphatemia=== | ||
*Internal redistribution | *Internal redistribution | ||
**Refeeding of malnourished | **[[refeeding syndrome|Refeeding of malnourished]] | ||
**[[DKA]] | **[[DKA]] | ||
**[[Nonketotic hyperglycemia]] | **[[Nonketotic hyperglycemia]] | ||
| Line 28: | Line 29: | ||
**[[Fanconi syndrome]] | **[[Fanconi syndrome]] | ||
***[[Multiple myeloma]] | ***[[Multiple myeloma]] | ||
**Osmotic diuresis (most often due to glucosuria) | **Osmotic diuresis (most often due to [[hyperglycemia|glucosuria]]) | ||
**Proximally acting diuretics (e.g. [[acetazolamide]] and some [[thiazide diuretics]]) | **Proximally acting [[diuretics]] (e.g. [[acetazolamide]] and some [[thiazide diuretics]]) | ||
**Acute volume expansion | **Acute volume expansion | ||
**Intravenous iron administration | **Intravenous [[iron supplementation|iron administration]] | ||
*Renal replacement therapy (dialysis) | *Renal replacement therapy ([[dialysis complications|dialysis]]) | ||
== | ==Evaluation== | ||
*2.5-2.8 Mild | *2.5-2.8 Mild | ||
*1.0-2.5 | *1.0-2.5 Moderate | ||
*<1.0 Severe | *<1.0 Severe | ||
== | ==Management== | ||
*Mild- | *Mild-moderate | ||
**KPhos /neutra phos PO | **KPhos /neutra phos PO | ||
*Severe | *Severe | ||
**KPhos 2.5- | **KPhos 2.5-5mg/kg IV over 6hr | ||
===Harbor UCLA Adult Treatment Guidelines=== | ===Harbor UCLA Adult Treatment Guidelines=== | ||
'''Serum phosphate 1mg/dl to 2mg/dl''' | |||
*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 | **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 | ***Peripheral administration may cause burning at injection site | ||
***Consider central venous administration, if available | ***Consider central venous administration, if available | ||
**If patient can | ***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== | ==See Also== | ||
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