Selection: adult (>= 18 years of age) patients in the ICU with hypophosphatemia
Exclusions:
(1) creatinine clearance < 25 mL/min
(2) serum creatinine > 4.0 mg/dL
(3) urine output < 30 mL per hour 2 hours before supplementation
(4) serum calcium corrected for serum albumin < 7.5 mg/dL
(5) corrected calcium * phosphorus product >= 60 mg/dL
(6) receipt of phosphorus containing parenteral nutrition
(7) body weight < 40 kg or > 120 kg
where:
• The correction of the serum calcium for a low serum albumin is discussed earlier in the chapter. One equation is: approximate total serum calcium with normal albumin, in mg/dL = (current total serum calcium in mg/dL) + (0.8 * (4 - (albumin in g/dL)))
|
Serum Inorganic Phosphorus
|
Severity of Hypophosphatemia
|
|
< 1.5 mg/dl
|
severe
|
|
1.5 - 2.2 mg/dL
|
moderate
|
Parameters:
(1) body weight
(2) serum phosphorus concentration
(3) serum potassium
Repletion solution for intravenous (IV) replacement.
|
Body Weight
|
Phosphorus
< 1.0 mg/dL
|
Phosphorus
1.0 - 1.7 mg/dL
|
Phosphorus
1.8 - 2.2 mg/dL
|
|
40 - 60 kg
|
30 mmol
|
20 mmol
|
10 mmol
|
|
61 - 80 kg
|
40 mmol
|
30 mmol
|
15 mmol
|
|
81 - 120 kg
|
50 mmol
|
40 mmol
|
20 mmol
|
|
Serum Potassium
|
Phosphorus Cation
|
|
< 4.0 mmol/L
|
potassium
|
|
>= 4.0 mmol/L
|
sodium
|
About two-thirds to three quarters of patients will be corrected after a single IV dose. Additional infusions can be given in those not corrected.
