Serum phosphate level in burn patients

Loghmani, Shahriar; Maracy, Mohammad Reza; Kheirmand, Reza

doi:10.1016/j.burns.2009.12.009

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…PhoR is an inner membrane histidine kinase while PhoB is response regulator DNA binding protein [ 69 ]. Phosphate levels higher than 4 μM (about 38 μg/dL) repress the operon [ 70 ]. Phosphate levels within the blood of healthy individuals (2400–4100 μg/dL) and severely burned patients (1600–2700 μg/dL) are significantly higher than those required to repress the Pho regulon ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

Major Transcriptome Changes Accompany the Growth of Pseudomonas aeruginosa in Blood from Patients with Severe Thermal Injuries

et al. 2016

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Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes serious infections in immunocompromised hosts including severely burned patients. After multiplying within the burn wound, P. aeruginosa translocate into the bloodstream causing bacterial sepsis frequently leading to organ dysfunction and septic shock. Although the pathogenesis of P. aeruginosa infection of thermally-injured wounds has been extensively analyzed, little is known regarding the ability of P. aeruginosa to adapt and survive within the blood of severely burned patients during systemic infection. To identify such adaptations, transcriptome analyses (RNA-seq) were conducted on P. aeruginosa strain PA14 that was grown in whole blood from a healthy volunteer or three severely burned patients. Compared with growth in blood from healthy volunteers, growth of PA14 in the blood from severely burned patients significantly altered the expression of 2596 genes, with expression of 1060 genes enhanced, while that of 1536 genes was reduced. Genes whose expression was significantly reduced included genes related to quorum sensing, quorum sensing-controlled virulence factors and transport of heme, phosphate, and phosphonate. Genes whose expression was significantly enhanced were related to the type III secretion system, the pyochelin iron-acquisition system, flagellum synthesis, and pyocyanin production. We confirmed changes in expression of many of these genes using qRT-PCR. Although severe burns altered the levels of different blood components in each patient, the growth of PA14 in their blood produced similar changes in the expression of each gene. These results suggest that, in response to changes in the blood of severely burned patients and as part of its survival strategy, P. aeruginosa enhances the expression of certain virulence genes and reduces the expression of others.

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Section: Resultsmentioning

confidence: 99%

Major Transcriptome Changes Accompany the Growth of Pseudomonas aeruginosa in Blood from Patients with Severe Thermal Injuries

et al. 2016

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“…Causes include impaired intestinal uptake, intracellular shifts from respiratory alkalosis, glucose/insulin therapy, catecholamines, refeeding syndrome, and increased losses from continuous renal replacement therapy (CRRT) [1,2,3,4,5,6]. The incidence of hypophosphatemia in patients on CRRT ranges from 11 to 65%, depending on the intensity and duration of treatment [7,8].…”

Section: Introductionmentioning

confidence: 99%

Biochemical Effects of Phosphate-Containing Replacement Fluid for Continuous Venovenous Hemofiltration

Chua

Baldwin

et al. 2012

Blood Purif

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Aims: To examine biochemical effects of phosphate-containing replacement fluid (Phoxilium®) for continuous venovenous hemofiltration (CVVH). Methods: Retrospective comparison of respective serum biochemistry with sequential use of Accusol™ and Phoxilium, each over 48 h of CVVH. Results: We studied 15 critically ill patients. Accusol was switched to Phoxilium after 5 (4–8) days of CVVH. Respective serum biochemistry after 36–42 h of Accusol versus Phoxilium were: phosphate 1.02 (0.82–1.15) versus 1.44 (1.23–1.78) mmol/l, ionized calcium 1.28 (1.22–1.32) versus 1.12 (1.06–1.21) mmol/l, bicarbonate 24 (23–25) versus 20 (19–22) mmol/l, base excess 0 (–2 to 1) versus –4 (–6 to –3) mmol/l (p < 0.001). Cumulative phosphate intakes during respective periods were 69.6 (56.6–76.6) versus 67.2 (46.6–79.0) mmol (p = 0.45). Plasma strong ion differences were narrower with Phoxilium (p < 0.05), with similar strong ion gaps. No additional intravenous phosphate was given during Phoxilium use. Seven patients had serum phosphate >1.44 mmol/l. Conclusions: Phoxilium versus Accusol use during CVVH effectively prevented hypophosphatemia but contributed to mild hyperphosphatemia, and is associated with relative hypocalcemia and metabolic acidosis.

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“…[1][2][3]7,9 In any patient, two main paths to hypophosphatemia include internal redistribution and external losses (via urine and GI tract) exist. Reduction in urinary excretion is found after burn injury, implying the etiology is not renal in this population.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Hypophosphatemia After Burn Injury With a Protocol for Continuous, Preemptive Repletion

Kahn

Bell

Stassen

et al. 2015

Journal of Burn Care & Research

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Severe burn injury has been shown to result in hypophosphatemia. Hypophosphatemia can cause cardiac, hematologic, immunologic, and neuromuscular dysfunction. This study compares serum phosphate levels and outcomes in patients who were administered a continuous, preemptive phosphate repletion protocol vs those who only received phosphate supplementation after they developed hypophosphatemia. Records of patients with greater than 19% TBSA burn admitted to the intensive care unit from 2006 to 2010 were reviewed. Patients were divided into two groups: historical controls who received responsive repletion when serum phosphate levels were less than 2.5 mg/dl (2006-2008) and the experimental group that received 30 mmol intravenous every 6 hours starting at approximately 24 hours after injury as long as serum phosphate levels were less than 4 mg/dl (2008-2010). Patients with chronic kidney disease or acute kidney injury were excluded. Data collected included age, weight, burn size, age, all serum phosphate levels, and total amount of phosphate administered. Differences in groups were compared with Mann-Whitney U test and Fisher's exact test. A total of 30 patients were included in the study, 20 in the responsive repletion group and 10 in the continuous repletion group. No significant difference was detected in age, sex, burn size, or full thickness burn size between groups. The continuous group had a statistically lower percentage of hypophosphatemic lab values compared with the responsive group, 13 ± 14% vs 45 ± 21% (P < .0001). No difference was found in percent of observations reflecting hyperphosphatemia (median of 2% in each group, P = .7). Four patients in the continuous group suffered cardiac and/or infectious complications compared with 16 in the responsive group (P = .04). Continuous, pre-emptive repletion of phosphate prevents hypophosphatemia after severe burn injury when compared with responsive repletion in historical controls. The protocol resulted in less hypophosphatemia without increasing the risk of hyperphosphatemia. This study also suggests that continuous repletion may result in fewer complications, but this needs to be confirmed in larger, prospective studies.

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Serum phosphate level in burn patients

Cited by 15 publications

References 16 publications

Major Transcriptome Changes Accompany the Growth of Pseudomonas aeruginosa in Blood from Patients with Severe Thermal Injuries

Major Transcriptome Changes Accompany the Growth of Pseudomonas aeruginosa in Blood from Patients with Severe Thermal Injuries

Biochemical Effects of Phosphate-Containing Replacement Fluid for Continuous Venovenous Hemofiltration

Prevention of Hypophosphatemia After Burn Injury With a Protocol for Continuous, Preemptive Repletion

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