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Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume.
J Crit Care. 2013 Oct; 28(5):838-43.JC

Abstract

BACKGROUND

Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available.

OBJECTIVE

To evaluate an individualized phosphate replacement regimen.

DESIGN

Fifty consecutive intensive care unit patients with a serum phosphate level<0.6 mmol/L were treated with sodium-potassium-phosphate intravenously at a rate of 10 mmol/h. The dose was calculated according to the following equation: Phosphate dose in mmol=0.5×Body Weight×(1.25-[serum Phosphate]). Phosphate levels were measured immediately upon completion of the infusion, as well as the next morning at 8 am.

RESULTS

Post-infusion phosphate levels were >0.6 mmol/L in 98% of the patients. Hyperphosphatemia, hyperkalemia or a decrease in serum calcium were not observed. In about a third of patients serum phosphate decreased to <0.6 mmol/L within the next 24 hours after infusion. The phosphate distribution volume calculated from the results of infusion and corrected for renal phosphate loss during the infusion period was 0.51 L/kg (95% CI 0.42-0.61 L/kg).

CONCLUSION

This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.

Authors+Show Affiliations

Department of Internal Medicine, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands. Electronic address: annekebech@hotmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23642477

Citation

Bech, Anneke, et al. "Hypophosphatemia On the Intensive Care Unit: Individualized Phosphate Replacement Based On Serum Levels and Distribution Volume." Journal of Critical Care, vol. 28, no. 5, 2013, pp. 838-43.
Bech A, Blans M, Raaijmakers M, et al. Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume. J Crit Care. 2013;28(5):838-43.
Bech, A., Blans, M., Raaijmakers, M., Mulkens, C., Telting, D., & de Boer, H. (2013). Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume. Journal of Critical Care, 28(5), 838-43. https://doi.org/10.1016/j.jcrc.2013.03.002
Bech A, et al. Hypophosphatemia On the Intensive Care Unit: Individualized Phosphate Replacement Based On Serum Levels and Distribution Volume. J Crit Care. 2013;28(5):838-43. PubMed PMID: 23642477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume. AU - Bech,Anneke, AU - Blans,Michiel, AU - Raaijmakers,Monique, AU - Mulkens,Chantal, AU - Telting,Darryl, AU - de Boer,Hans, Y1 - 2013/04/30/ PY - 2013/01/02/received PY - 2013/02/27/revised PY - 2013/03/03/accepted PY - 2013/5/7/entrez PY - 2013/5/7/pubmed PY - 2014/5/28/medline KW - Hypophosphatemia KW - ICU KW - Phosphate replacement SP - 838 EP - 43 JF - Journal of critical care JO - J Crit Care VL - 28 IS - 5 N2 - BACKGROUND: Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. OBJECTIVE: To evaluate an individualized phosphate replacement regimen. DESIGN: Fifty consecutive intensive care unit patients with a serum phosphate level<0.6 mmol/L were treated with sodium-potassium-phosphate intravenously at a rate of 10 mmol/h. The dose was calculated according to the following equation: Phosphate dose in mmol=0.5×Body Weight×(1.25-[serum Phosphate]). Phosphate levels were measured immediately upon completion of the infusion, as well as the next morning at 8 am. RESULTS: Post-infusion phosphate levels were >0.6 mmol/L in 98% of the patients. Hyperphosphatemia, hyperkalemia or a decrease in serum calcium were not observed. In about a third of patients serum phosphate decreased to <0.6 mmol/L within the next 24 hours after infusion. The phosphate distribution volume calculated from the results of infusion and corrected for renal phosphate loss during the infusion period was 0.51 L/kg (95% CI 0.42-0.61 L/kg). CONCLUSION: This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/23642477/Hypophosphatemia_on_the_intensive_care_unit:_individualized_phosphate_replacement_based_on_serum_levels_and_distribution_volume_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(13)00063-4 DB - PRIME DP - Unbound Medicine ER -