1. Hypophosphatemia on the intensive care unit: Individualized phosphate replacement based on serum levels and distribution volume.
- Author
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Bech, Anneke, Blans, Michiel, Raaijmakers, Monique, Mulkens, Chantal, Telting, Darryl, and de Boer, Hans
- Subjects
HOSPITAL admission & discharge ,CARDIAC arrest ,PANCREATITIS diagnosis ,SEPSIS ,PATIENTS ,HYPOPHOSPHATEMIA ,ACADEMIC medical centers ,APACHE (Disease classification system) ,BIOLOGICAL assay ,BODY weight ,CALCIUM ,CONFIDENCE intervals ,CRITICAL care medicine ,DRUG infusion pumps ,INSULIN ,INTENSIVE care units ,KIDNEY diseases ,PHARMACEUTICAL arithmetic ,PHOSPHATES ,POTASSIUM ,RESPIRATORY insufficiency ,SURGICAL complications ,THERAPEUTICS ,DATA analysis ,DESCRIPTIVE statistics ,DIAGNOSIS - 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. Design: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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