title: Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial.
abstract: OBJECTIVE
  To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  A 455-bed tertiary care institution, with Level I trauma designation.
  
  
  METHODS
  Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of < 3 mg/dL (< 0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity.
  
  
  METHODS
  Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (< 1.5 mg/dL [< 0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days.
  
  
  RESULTS
  Sixty-seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 +/- 0.6 to 3.3 +/- 0.6 mg/dL (0.84 +/- 0.19 to 1.1 +/- 0.19 mmol/L) for the mild group; 1.9 +/- 0.6 to 2.7 +/- 0.6 mg/dL (0.61 +/- 0.19 to 0.87 +/- 0.19 mmol/L) for the moderate group; 1.3 +/- 0.8 to 2.3 +/- 0.8 mg/dL (0.42 +/- 0.26 to 0.74 +/- 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period.
  
  
  CONCLUSIONS
  The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Clark
authors.forename: G S
authors.initials: GS
authors.lastname: Sacks
authors.forename: R N
authors.initials: RN
authors.lastname: Dickerson
authors.forename: K A
authors.initials: KA
authors.lastname: Kudsk
authors.forename: R O
authors.initials: RO
authors.lastname: Brown
mesh_terms: D000328:Adult; D001806:Blood Urea Nitrogen; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004573:Electrolytes / Q000097:blood; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D010758:Phosphorus / Q000008:administration & dosage*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D004573:Electrolytes; D010758:Phosphorus