A New Graduated Dosing Regimen for Phosphorus Replacement in Patients Receiving Nutrition Support

Brown, Kaleb A.; Dickerson, Roland N.; Morgan, Laurie M.; Alexander, Kathryn H.; Minard, Gayle; Brown, Rex O.

doi:10.1177/0148607106030003209

Cited by 57 publications

(35 citation statements)

References 32 publications

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“…A few different regimens based on patient weight and serum [P] have now been published, but these have been primarily in critically ill trauma patients and surgical ICU patients with normal renal function. [61][62][63] There are several other published reports of fixed-dose phosphate supplementation in patients with normal renal function. [64][65][66][67][68][69][70] Based on these published reports, Table 2 provides one approach to IV P dosing for treating hypophosphatemia in patients with normal renal function.…”

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

“…In addition, oral P absorption may be decreased in patients with vitamin D deficiency. 5,72 Some have added P supplements directly to EN formulas (either oral or IV dosage formulations), 56,62 and this approach may be efficacious when treating asymptomatic hypophosphatemia, 56 although recent guidelines do not recommend this practice. 71 One report of 2 malnourished patients demonstrated enteral P contained in EN formulations was not adequate to prevent hypophosphatemia and ultimately required IV supplementation to correct serum [P], although there may have also been other contributing factors in these cases.…”

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

“…Several published studies on the treatment of hypophosphatemia describe monitoring serum [P] within approximately 12-24 hours after supplementation or on a daily basis. [61][62][63]65,69 Despite this, it may be prudent to monitor serum [P] more frequently in some patients with severe hypophosphatemia until serum concentrations normalize. Administer additional P supplements until the patient is asymptomatic and the serum [P] is at least >2.0 mg/dL; the goal is to return the serum [P] to the normal range (ie, 2.7-4.5 mg/dL) and avoid symptoms.…”

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

“…Some patients will require multiple doses over several days to completely correct hypophosphatemia, especially those with severe malnutrition/refeeding syndrome, those with P depletion, and critically ill patients. 57,61,62,65,70,74 Finally, when using weight-based dosing, there are no definitive data or recommendations for "adjusting" weight in obese patients or what threshold should be used to adjust weight (eg, using a percentage above ideal body weight [IBW] or based on body mass index). Total body water is slightly higher in males than in females, and adipose tissue is composed of approximately 10%-30% water.…”

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

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Phosphorus and Calcium

Kraft

2014

Nut in Clin Prac

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Phosphorus (P) and calcium (Ca) serve vital roles in the human body and are essential components of nutrition support therapy. Regulation of P and regulation of Ca in the body are closely interrelated, and P and Ca homeostasis can be affected by several factors, including disease states, clinical condition, severity of illness, and medications. Nutrition support clinicians must understand these factors to prevent and treat P and Ca disorders in patients receiving nutrition support therapy. This review provides an overview of P and Ca for the adult nutrition support clinician, with some emphasis on the hospitalized inpatient.

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Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

Section: And Ca Compatibility In Pn Admixturesmentioning

confidence: 99%

See 2 more Smart Citations

Phosphorus and Calcium

Kraft

2014

Nut in Clin Prac

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“…Intravenous therapy is generally recommended in symptomatic hypophosphatemia and phosphate levels <0.32 mmol/L. Multiple studies have evaluated the efficacy and safety of intravenous phosphate repletion regimens (Table 4) [61-67]. These studies generally agree that aggressive phosphate supplementation is safe with phosphate doses up to 45 mmol with infusion rates up to 20 mmol per hour.…”

Section: Resultsmentioning

confidence: 99%

Treatment of hypophosphatemia in the intensive care unit: a review

et al. 2010

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IntroductionCurrently no evidence-based guideline exists for the approach to hypophosphatemia in critically ill patients.MethodsWe performed a narrative review of the medical literature to identify the incidence, symptoms, and treatment of hypophosphatemia in critically ill patients. Specifically, we searched for answers to the questions whether correction of hypophosphatemia is associated with improved outcome, and whether a certain treatment strategy is superior.ResultsIncidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Treatment: hypophosphatemia is generally corrected when it is symptomatic or severe. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Outcome: in some studies, hypophosphatemia was associated with higher mortality; a paucity of randomized controlled evidence exists for whether correction of hypophosphatemia improves the outcome in critically ill patients.ConclusionsAdditional studies addressing the current approach to hypophosphatemia in critically ill patients are required. Studies should focus on the association between hypophosphatemia and morbidity and/or mortality, as well as the effect of correction of this electrolyte disorder.

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Quality improvement project in a neonatal intensive care unit reduced the prevalence and duration of hypophosphatemia with significant and sustainable results

et al. 2023

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BackgroundHypophosphatemia is associated with prolonged mechanical ventilation and may affect growth, bone mineralization, nephrocalcinosis, and mortality in preterm infants. Optimal nutrition practices may decrease risk for hypophosphatemia and improve outcome.MethodsA quality improvement project was established to improve parenteral and enteral phosphorus intake with the goal to decrease prevalence and duration of hypophosphatemia in the first 14 days in infants <32 weeks' gestation.ResultsAmong 406 preterm infants, the prevalence of moderate hypophosphatemia decreased from 44% to 19% (P < 0.01) over 4 years. The median duration of moderate hypophosphatemia decreased from 72 h (48–128) to 24 (24–53) (P < 0.01). Daily intakes of parenteral calcium and phosphorus on the fourth day of life increased from 1.5 to 2.5 mEq/kg/day (P < 0.01) and 0.6 to 1.3 mmol/kg/day (P < 0.01), respectively. The median postnatal age of first serum phosphorus concentration assessment decreased from 53 h (41–64) to 32 (24–40) (P < 0.01).ConclusionDuring this quality improvement project, reduced prevalence and duration of hypophosphatemia in infants <32 weeks' gestation in the first 14 days of life was achieved through the optimization of parenteral and enteral phosphorus intake and improved response to acute hypophosphatemia.

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A New Graduated Dosing Regimen for Phosphorus Replacement in Patients Receiving Nutrition Support

Abstract: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate and severe-dose regimens effectively increase serum phosphorus concentrations.

Cited by 57 publications

References 32 publications

Phosphorus and Calcium

Phosphorus and Calcium

Treatment of hypophosphatemia in the intensive care unit: a review

Quality improvement project in a neonatal intensive care unit reduced the prevalence and duration of hypophosphatemia with significant and sustainable results

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