title: Intravenous phosphate in the intensive care unit: more aggressive repletion regimens for moderate and severe hypophosphatemia.
abstract: OBJECTIVE
  To evaluate efficacy and safety of aggressive correction of hypophosphatemia with intravenous potassium phosphate in the ICU.
  
  
  METHODS
  Randomized interventional prospective study in the medical and surgical ICU of a tertiary university hospital.
  
  
  METHODS
  Critically ill patients with hypophosphatemia between June and November 1998.
  
  
  RESULTS
  Patients with moderate hypophosphatemia (<0.65 and >0.40 mmol/l; n=37) were randomized into two groups: group 1 received 30 mmol potassium phosphate intravenously in 50 ml saline over 2 h, and group 2 received 30 mmol potassium phosphate in 100 ml saline over 4 h. Patients with severe hypophosphatemia (<0.40 mmol/l; n=10) were also randomized into two groups: group 3 received 45 mmol potassium phosphate intravenously in 100 ml saline over 3 h, and group 4 received 45 mmol potassium phosphate in 100 ml saline over 6 h. Electrolytes, blood gas, renal function were monitored until day 3; urine was collected during and until 6 h after infusions. The overall efficacy of the protocols was 98% by the end of the infusion. There was no statistical difference in phosphate values between groups at the end of infusion or at 24 h. No adverse events were noted; one patient had an increase in serum potassium to 6.1 mmol/l. Phosphaturia in all groups was elevated as evidenced by fractional excretion above 20%.
  
  
  CONCLUSIONS
  More rapid administration of large potassium phosphate boluses is effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function if baseline serum potassium is below 4 mmol/l.
authors.affiliation: Medical and Surgical Intensive Care Units, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 de l'Assomption, H1T 2M4, Montreal, PQ, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Charron
authors.forename: Francis
authors.initials: F
authors.lastname: Bernard
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
authors.forename: Nathalie
authors.initials: N
authors.lastname: Simoneau
authors.forename: Nadine
authors.initials: N
authors.lastname: Gagnon
authors.forename: Martine
authors.initials: M
authors.lastname: Leblanc
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000188:drug therapy* / Q000503:physiopathology; D007260:Infusion Pumps; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000008:administration & dosage / Q000627:therapeutic use*; D017680:Potassium Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010710:Phosphates; D017680:Potassium Compounds; C013216:potassium phosphate