Hemodynamic and metabolic effects of rapid correction of hypophosphatemia in patients with septic shock.
OBJECTIVE
To examine the hemodynamic and metabolic short-term effects of hypophosphatemia correction in patients with septic shock receiving catecholamine therapy.


METHODS
Prospective, single cohort study.


METHODS
ICU, university hospital.


METHODS
Ten patients with septic shock and hypophosphatemia below 2 mg/dL.


METHODS
Infusion of glucose-1-phosphate solution (20 mmol of elemental phosphorus) for 60 min.


RESULTS
Hemodynamic, oxygen-derived, acid-base, and electrolyte parameters before and immediately after phosphate infusion. Left ventricular stroke work index increased significantly (22%) from a mean low value of 24 +/- 10 g/m2 without changes in filling pressures. Systolic arterial pressure improved by 12%. Arterial pH improved slightly but significantly. Ionized calcium level slightly decreased within the normal range values. Other parameters remained unchanged.


CONCLUSIONS
Severe hypophosphatemia may be considered as a superimposed cause of myocardial depression, inadequate peripheral vasodilatation, and acidosis in septic shock. A rapid correction of hypophosphatemia is well tolerated and may have both myocardial and vascular beneficial effects. The magnitude of the response, however, is variable and unpredictable on the basis of serum phosphorus levels.
Bollaert
P E
PE
Service de Réanimation Médicale, Hopital Central, Centre Hospitalier Universitaire, Nancy, France.
Levy
B
B
Nace
L
L
Laterre
P F
PF
Larcan
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005958:Glucosephosphates / Q000008:administration & dosage; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D017674:Hypophosphatemia / Q000209:etiology / Q000628:therapy*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D013318:Stroke Volume; D016277:Ventricular Function, Left
D005958:Glucosephosphates; C031590:glucose-1-phosphate; D002118:Calcium