Hypophosphatemia

Hypophosphatemia

  • Can be due to:
    • Redistribution of Phosphate from ECF into cells (usually either due to increased insulin secretion or acute respiratory alkalosis
    • Decreased intestinal absorption of phosphate (due to inadequate intake of Phos–alcoholics, antacids containing Al or Mg, chronic diarrhea, vitamin D deficiency
    • Increased urinary Phos excretion (due to either primary or secondary hyperparathyroidism, osmotic diuresis, acetazolamide or acute volume expansion)
  • Signs/symptoms:  parathesias, muscle weakness/myalgias, bone pain, anorexia, n/v, RBC hemolysis, acute respiratory failure, CHF, confusion, seizures, coma
  • Causes:  malnutrition, TPN w/o adequate supplementation, too aggressive of feeding to malnourished patients, induced respiratory alkalosis, hyperventiliation, recovery from severe burns, vitamin D deficiency, hyperparathyroidism, hypokalemia/hypomagnesemia
  • Medication causes:  diuretics, sucralfate, corticosteroids, cisplatin, antacids, foscarnet, phenytoin/phenobarb, phosphate binders
  • Trxt:
    • If mild: eat a high phosphorous diet (eggs, nuts, whole grains, meat, fish, poultry, milk products)
    • If moderate:  oral therapy
      • Uro-KP Neutral Tablets:  dissolve 1-2 tablets in 6-8 ounces of water QID PC & HS.   For best results, soak tablets in water for 2-5 minutes then stir and swallow
      • K-Phos Neutral 852 mg Tablets:  1-2 tablets QID after PC & HS
      • Phos-NaK 1.5 g packet:  1-2 packets QID PC & HS.  Dilute in 75 mL of water/juice.
    • If Severe:  Parenteral therapy

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