Intravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemia.
OBJECTIVE
To document the safety and efficacy of an intravenous phosphate repletion regimen that is more aggressive than recommended by previously published guidelines, in intensive care unit (ICU) patients with hypophosphatemia.


METHODS
Prospective evaluation of rapid, intravenous phosphate repletion in eligible patients.


METHODS
Surgical ICU in a teaching hospital.


METHODS
Patients with a serum phosphorus concentration of < 2 mg/dL (< 0.65 mmol/L) while in the ICU.


METHODS
Enrolled patients received 15 mmol of sodium phosphate in 100 mL of 0.9% sodium chloride, infused intravenously over a period of 2 hrs. Patients with a serum potassium concentration of < 3.5 mmol/L received potassium phosphate, if no other potassium supplementation was ordered. The same dose could be repeated to a maximum of 45 mmol in a 24-hr period if either the 6-hr or follow-up (18- to 24-hr) postinfusion serum phosphorus remained < 2 mg/dL (< 0.65 mmol). Serum electrolytes, renal function, vital signs, and reflexes were closely monitored.


RESULTS
Eleven patients enrolled had baseline serum phosphorus values of 1.6 to 1.9 mg/dL (0.51 to 0.61 mmol/L). The serum phosphorus value immediately postinfusion was 2.3 to 5.3 mg/dL (0.74 to 1.7 mmol/L). Only one patient had a 6-hr postinfusion serum phosphorus of < 2 mg/dL (< 0.65 mmol/L), requiring two additional doses. Two other patients each required a second dose. Serum phosphorus was corrected in other patients with a single dose. No significant changes were noted in serum calcium, magnesium, or potassium concentrations, urine output, vital signs, or reflexes throughout the repletion period.


CONCLUSIONS
All patients were successfully repleted using the described protocol without any significant adverse effects. This repletion regimen may have widespread applicability in the ICU setting.
Rosen
G H
GH
Department of Pharmacy, University of Maryland Medical System, Baltimore, USA.
Boullata
J I
JI
O'Rangers
E A
EA
Enow
N B
NB
Shin
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D016638:Critical Illness; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000008:administration & dosage*; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors
D010710:Phosphates; D010758:Phosphorus