eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hyperphosphatemia: Follow-up

Author: Leigh A Patterson, MD, Assistant Professor, Interim Residency Director, Department of Emergency Medicine, Brody School of Medicine at East Carolina University
Coauthor(s): Peter MC DeBlieux, MD, Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Jan 31, 2008

Follow-up

Further Inpatient Care

  • Patients with hyperphosphatemia due to administration of liposomal amphotericin B who continue to require antifungal therapy may be switched to the formulation amphotericin B lipid complex, which contains less inorganic phosphate.1

Inpatient & Outpatient Medications

  • Phosphate binders
  • Calcium supplements, if needed

Transfer

  • Patients with severe hyperphosphatemia may require transfer to a facility with a dialysis center.

Complications

  • Complications resulting from the underlying cause of the hyperphosphatemia vary with the specific etiology.

Prognosis

  • Prognosis is determined primarily by the severity of the underlying disorder and of the hypocalcemia produced. With metastatic calcification, progressive organ damage occurs at areas of deposition.

Patient Education

  • Dietary education is very important for patients at risk for recurrent hyperphosphatemia.
    • Restrict dietary phosphorus to 0.6-0.9 g/d.
    • Avoid milk and milk products, meat, fish, poultry, eggs, and peanuts.
    • Avoid phosphorus-containing preparations such as laxatives, enemas, and supplements.
  • Maintain adequate hydration status.

Miscellaneous

Medicolegal Pitfalls

  • Use caution in ordering phosphate-containing enemas and laxatives for children and for patients with renal insufficiency.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor, Craig Feied, MD, to the development and writing of this article.



More on Hyperphosphatemia

Overview: Hyperphosphatemia
Differential Diagnoses & Workup: Hyperphosphatemia
Treatment & Medication: Hyperphosphatemia
Follow-up: Hyperphosphatemia
References
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References

  1. Sutherland SM, Hong DK, Balagtas J, Gutierrez K, Dvorak CC, Sarwal M. Liposomal amphotericin B associated with severe hyperphosphatemia. Pediatr Infect Dis J. Jan 2008;27(1):77-9. [Medline].

  2. Berner YN, Shike M. Consequences of phosphate imbalance. Annu Rev Nutr. 1988;8:121-48. [Medline].

  3. Bleyer AJ, Burke SK, Dillon M, et al. A comparison of the calcium-free phosphate binder sevelamer hydrochloride with calcium acetate in the treatment of hyperphosphatemia in hemodialysis patients. Am J Kidney Dis. Apr 1999;33(4):694-701. [Medline].

  4. Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis. Jun 2000;35(6):1226-37. [Medline].

  5. Card RT, Brain MC. The "anemia" of childhood: evidence for a physiologic response to hyperphosphatemia. N Engl J Med. Feb 22 1973;288(8):388-92. [Medline].

  6. Chan J, Gill J Jr, eds. Kidney Electrolyte Disorders. Churchill Livingston; 1990:247-60, 460.

  7. Chertow GM, Burke SK, Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. Jul 2002;62(1):245-52. [Medline].

  8. Fauci A, Braunwald E, et al, eds. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 1998:1510, 2217-8, 2243, 2245, 2262.

  9. Larner AJ. Pseudohyperphosphatemia. Clin Biochem. Aug 1995;28(4):391-3. [Medline].

  10. Liu YL, Lin HH, Yu CC, Kuo HL, Yang YF, Chou CY. A comparison of sevelamer hydrochloride with calcium acetate on biomarkers of bone turnover in hemodialysis patients. Ren Fail. 2006;28(8):701-7. [Medline].

  11. London GM, Pannier B, Marchais SJ, Guerin AP. Calcification of the aortic valve in the dialyzed patient. J Am Soc Nephrol. Apr 2000;11(4):778-83. [Medline].

  12. Medical Economics Staff. Physicians' Desk Reference. 54th ed. Medical Economics Co; 2000:811-2, 3339-40.

  13. Rostand SG. Coronary heart disease in chronic renal insufficiency: some management considerations. J Am Soc Nephrol. Oct 2000;11(10):1948-56. [Medline].

  14. Rutecki G, Whittier F. Decision points in hypocalcemia: is emergent therapy required?. J Crit Illn. 1998;13(2):84-90.

  15. Rutecki G, Whittier F. Life-threatening phosphate imbalance: when to suspect, how to treat. J Crit Illn. 1997;12(11):699-704.

  16. Schrier R, ed. Renal and Electrolyte Disorders. 4th ed. Boston: Little Brown & Co; 1992:287-315.

  17. Schrier R, Gottschalk C, eds. Diseases of the Kidney. 6th ed. Boston: Little Brown & Co; 1997:2490-4.

  18. Slatopolsky E. New developments in hyperphosphatemia management. J Am Soc Nephrol. Sep 2003;14(9 Suppl 4):S297-9. [Medline].

  19. Sutters M, Gaboury CL, Bennett WM. Severe hyperphosphatemia and hypocalcemia: a dilemma in patient management. J Am Soc Nephrol. Oct 1996;7(10):2056-61. [Medline].

  20. Thatte L, Oster JR, Singer I. Review of the literature: severe hyperphosphatemia. Am J Med Sci. Oct 1995;310(4):167-74. [Medline].

  21. Wang AY, Woo J, Sea MM, et al. Hyperphosphatemia in Chinese peritoneal dialysis patients with and without residual kidney function: what are the implications?. Am J Kidney Dis. Apr 2004;43(4):712-20. [Medline].

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Further Reading

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Keywords

phosphorus homeostasis, high phosphorus level, hyperphosphatemia, renal insufficiency, acute renal failure, chronic renal failure, end-stage renal disease, hypocalcemia, calcific uremic arteriolopathy, calciphylaxis, managing hyperphosphatemia and chronic kidney disease

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Contributor Information and Disclosures

Author

Leigh A Patterson, MD, Assistant Professor, Interim Residency Director, Department of Emergency Medicine, Brody School of Medicine at East Carolina University
Leigh A Patterson, MD is a member of the following medical societies: American College of Emergency Physicians, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Peter MC DeBlieux, MD, Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University Health Sciences Center
Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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