Nephrology Book

http://www.fpnotebook.com/

Phosphorus Replacement

Aka: Phosphorus Replacement, Phosphate Replacement
  1. See Also
    1. Hypophosphatemia
  2. Indications: Hypophosphatemia
    1. Serum Phosphorus < 2 mg/dl
      1. Symptom onset when phosphorus <2 mg/dl
      2. Severe symptoms (Muscle Weakness, Rhabdomyolysis) when Serum Phosphorus <1 mg/dl
    2. Serum Phosphate Replacement is not required in most cases
      1. Hypophosphatemia resolves spontaneously when primary cause is managed
      2. Treat Diabetic Ketoacidosis, Vomiting, Diarrhea, Vitamin D Deficiency and phosphate normalizes
  3. Preparations
    1. Oral
      1. K-Phos Tab
        1. Phosphorus: 8 mmol (250 mg)
      2. Neutra-Phos Tab
        1. Phosphorus: 8 mmol (250 mg)
      3. Fleets Phosphosoda
        1. Phosphorus: 4 mmol (128 mg)
    2. IV
      1. Sodium Phosphate
        1. Phosphorus: 3 mmol/ml
        2. Sodium: 4 meq/ml
      2. Potassium Phosphate (K-Phos)
        1. Phosphorus: 3 mmol/ml
        2. Potassium: 4.4 meq/ml
  4. Management: Oral Replacement
    1. Indications
      1. Serum phosphate 1.0 to 1.9 mg/dl
    2. Precautions
      1. Reduce dose to 50% in Chronic Kidney Disease
      2. Recheck serum phosphate 2-12 hours after last dose
    3. Dose: General
      1. Typical adult dose: 250-500 mg (8-16 mmol) orally four times daily for 24 hours, then recheck
    4. Dose: Serum Phosphorus 1.5 to 2.0 mg/dl
      1. Phosphorus 1 mmol/kg (min 40 and max of 80 mmol/day) divided four times daily x1 day
    5. Dose: Serum Phosphorus 1.0 to 1.5 mg/dl
      1. Phosphorus 1.3 mmol/kg (max of 100 mmol/day) divided four times daily x1 day
  5. Management: IV Replacement
    1. Indications
      1. Serum phosphate <1.0 mg/dl
      2. Switch to oral replacement when serum phosphate >1.5 mg/dl
    2. Precautions
      1. Avoid doses in excess of 0.24 mmol/kg if possible
      2. Use slower rates of replacement (0.08 to 0.20 mmol/kg) especially if more recent Hypophosphatemia onset
      3. Risk of precipitating calcium, with secondary Hypocalcemia, Acute Renal Failure and arrhythmias
    3. Dose: Serum Phosphorus 1.3 to 2.0 mg/dl
      1. Phosphorus 0.08 to 0.24 mmol/kg (max: 30 mmol) infused over 6 hours
    4. Dose: Serum Phosphorus <1.3 mg/dl
      1. Phosphorus 0.24 to 0.50 mmol/kg (max: 80 mmol) infused over 8 to 12 hours
  6. References
    1. Yu and Stubbs in Goldfarb (2014) Evaluation and treatment of Hypophosphatemia, UpToDate, accessed online 1/24/2014
    2. Medscape Sodium Phosphate
      1. http://reference.medscape.com/drug/sodium-phosphates-iv-999713
    3. Medscape Potassium Phosphate
      1. http://reference.medscape.com/drug/potassium-phosphate-iv-999714

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree