Phosphate supplementation for hypophosphataemia and parenteral nutrition

Abstract

Routine detection and treatment of acute hypophosphataemia is important in intensive care unit and many other hospitalized patients, but metabolic bone disease and hypophosphataemia are still experienced as a result of parenteral nutrition. A significantly common problem that faces the compounding pharmacist when formulating parenteral nutrition regimens is the difficulty associated with the successful avoidance of calcium phosphate precipitation. Although incorporation of the normal calcium and phosphate requirements into regimens for metabolically stable adults is usually achievable, it can prove impossible in paediatric and neonatal mixtures when using the standard inorganic sources that are currently licensed for use in the UK and USA. In other countries, where organic compounds are routinely available, this problem does not exist.

Factors contributing to the development of hypophosphataemia when refeeding using parenteral nutrition

“…Problems with calcium-phosphate precipitation in particular have dominated pharmaceutics research in this area [32][33][34]. It is crucial to observe limits to avoid serious clinical consequences of particulate infusion [35].…”

Metabolic bone disease of prematurity and secondary hyperparathyroidism

“…Assuming that a calcium retention level of 60–90 mg/kg/day (1.5–2.25 mmol/kg/day) assures appropriate mineralisation, an intake of 100–160 mg/kg/day (2.5–4 mmol/kg/day) of calcium, 60–90 mg/kg/day (1.9–2.85 mmol/kg/day) of phosphate and 800–1000 IU/day of vitamin D is recommended 7 . Incompatibility and calcium phosphate precipitation at higher doses do not allow incorporation of additional minerals through parenteral nutrition 8 . Micropremies depend upon placental transfer of vitamin D as the major source.…”

Management of hypophosphatemia in nocturnal hemodialysis with phosphate-containing enema: A technical study

“…We chose to use this technique as visual inspection of particles is unreliable due to interobserver variability. Also, the human eye is incapable of detecting particles below 40 μm 11 . Using an optical densitometer, no precipitate was detected after adding up to 60 mL of Fleet ® enema in the acid concentrate.…”