Hypophosphatemia

Background

• 2.5-2.8 Mild
• 1.0-2.5 Mod
• <1.0 Severe

Diagnosis

• CNS
  • Weakness
  • Circumoral and fingertip paresthesias
  • Decreased DTRs
  • Decreased Mental Status
• Cardiac
  • Impaired myocardial function

Treatment

1. Mild-mod
   1. KPhos /neutra phos PO
2. Severe
   1. KPhos 2.5-5 mg/kg IV over 6hr

• If <2.4:
  • Neutra-Phos 2 packets PO Q6hr x 48hr OR sodium phosphate 30mmol IV
• If <1:
  • IV Sodium Phosphate 45mmol should be used

Harbor UCLA Adult Treatment Guidelines

1. Serum phosphate <2 mg/dl, but >1 mg/dl AND the patient IS able to take PO
   1. Minimize or eliminate all dextrose-containing IV solutions
   2. Aggressively treat acidosis
   3. 1 tab K-phos neutral 250mg Q hour x 5 doses
      1. Each tab contains phosphorus 8 mmol, Na 13 mEq, K1.1 mEq
   4. Recheck serum phosphate after last dose, and repeat dosing if continues to be <2 mg/dl
2. Serum phosphate <2 mg/dl, but >1 mg/dl BUT the patient is NOT able to take PO
   1. Minimize or eliminate all dextrose-containing IV solutions
   2. Aggressively treat acidosis
   3. Give 15 mmol of IV potassium phosphate over 2.5 hours (contains 22 mEq K)
      1. Peripheral administration may cause burning at injection site
      2. Consider central venous administration, if available
      3. Repeat dosing regimen if serum phosphate remains <2 mg/dl
3. Serum phosphate <1 mg/dl
   1. Minimize or eliminate all dextrose-containing IV solutions
      1. Exceptions: vasopressors, sedatives, analgesics, antibiotics, blood products, NS
   2. Aggressively treat acidosis
   3. Give 45 mmol of IV potassium phosphate over 7 hours (contains 66 mEq of K)
      1. Peripheral administration may cause burning at injection site
      2. Consider central venous administration, if available
   4. If patient can tolerat PO, ALSO follow steps 1 above
   5. Recheck serum phosphate after infusion
      1. Repeat IV administration if <1 mg/dl
      2. Consider oral administration if >1mg and <2 mg/dl