title: Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume.
abstract: BACKGROUND
  Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available.
  
  
  OBJECTIVE
  To evaluate an individualized phosphate replacement regimen.
  
  
  METHODS
  Fifty consecutive intensive care unit patients with a serum phosphate level<0.6 mmol/L were treated with sodium-potassium-phosphate intravenously at a rate of 10 mmol/h. The dose was calculated according to the following equation: Phosphate dose in mmol=0.5×Body Weight×(1.25-[serum Phosphate]). Phosphate levels were measured immediately upon completion of the infusion, as well as the next morning at 8 am.
  
  
  RESULTS
  Post-infusion phosphate levels were >0.6 mmol/L in 98% of the patients. Hyperphosphatemia, hyperkalemia or a decrease in serum calcium were not observed. In about a third of patients serum phosphate decreased to <0.6 mmol/L within the next 24 hours after infusion. The phosphate distribution volume calculated from the results of infusion and corrected for renal phosphate loss during the infusion period was 0.51 L/kg (95% CI 0.42-0.61 L/kg).
  
  
  CONCLUSIONS
  This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.
authors: Department of Internal Medicine, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands. Electronic address: annekebech@hotmail.com.
authors: Anneke
authors: A
authors: Bech
authors: Michiel
authors: M
authors: Blans
authors: Monique
authors: M
authors: Raaijmakers
authors: Chantal
authors: C
authors: Mulkens
authors: Darryl
authors: D
authors: Telting
authors: Hans
authors: H
authors: de Boer
mesh_terms: D018806:APACHE; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D010710:Phosphates / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010710:Phosphates; C018279:sodium phosphate
keywords: Hypophosphatemia; ICU; Phosphate replacement