Hypophosphatemia in Emergency Medicine Medication

  • Author: Devon J Moore, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 26, 2012
 

Medication Summary

Treatment depends on the symptoms and severity of the condition.

Next

Electrolyte supplements

Class Summary

These agents are used to increase serum phosphorus to normal physiologic levels.

View full drug information

Potassium phosphate/sodium acid phosphate

 

IV preparations are available as sodium phosphate (Na2 HPO4 and NAH2 PO4) or potassium phosphate (K2 HPO4 and KH2 PO4).

Response to IV phosphorus supplementation varies widely and may be associated with hyperphosphatemia and hypocalcemia. Rate of infusion and choice of initial dosage should be based on severity of hypophosphatemia and presence of symptoms.

When treating hypophosphatemia with potassium phosphate, potassium level may limit amount of phosphate that can be given safely.

One Canadian group recently reported administering 30 mmol of potassium phosphate via central line over 3 h for severe hypophosphatemia and 15 mmol of potassium phosphate via central line over 3 h for moderate hypophosphatemia.

Another study reported safely administering IV phosphate at a rate of 14.5 mmol of phosphate ions over 1 h.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Devon J Moore, MD  Resident Physician, Department of Emergency Medicine, Wayne State University Detroit Medical Center, Detroit Receiving Hospital

Devon J Moore, MD is a member of the following medical societies: American Medical Student Association/Foundation, Emergency Medicine Residents Association, and Wayne State School of Medicine Black Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD 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.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

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

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

  1. Shaikh A, Berndt T, Kumar R. Regulation of phosphate homeostasis by the phosphatonins and other novel mediators. Pediatr Nephrol. Aug 2008;23(8):1203-10. [Medline].

  2. Datta BN, Stone MD. Hyperventilation and hypophosphataemia. Ann Clin Biochem. Mar 2009;46:170-1. [Medline].

  3. Mehanna H, Nankivell PC, Moledina J, Travis J. Refeeding syndrome - awareness, prevention and management. Head Neck Oncol. Jan 26 2009;1(1):4. [Medline].

  4. Nowik M, Picard N, Stange G, Capuano P, Tenenhouse HS, Biber J, et al. Renal phosphaturia during metabolic acidosis revisited: molecular mechanisms for decreased renal phosphate reabsorption. Pflugers Arch. Nov 2008;457(2):539-49. [Medline].

  5. Rastegar A. New concepts in pathogenesis of renal hypophosphatemic syndromes. Iran J Kidney Dis. Jan 2009;3(1):1-6. [Medline].

  6. Faroqui S, Levi M, Soleimani M, Amlal H. Estrogen downregulates the proximal tubule type IIa sodium phosphate cotransporter causing phosphate wasting and hypophosphatemia. Kidney Int. May 2008;73(10):1141-50. [Medline].

  7. Bates JA. Phosphorus: a quick reference. Vet Clin North Am Small Anim Pract. May 2008;38(3):471-5, viii. [Medline].

  8. Sebastian S, Clarence D, Newson C. Severe hypophosphataemia mimicking Guillain-Barré syndrome. Anaesthesia. Aug 2008;63(8):873-5. [Medline].

  9. Bastepe M, Juppner H. Inherited hypophosphatemic disorders in children and the evolving mechanisms of phosphate regulation. Rev Endocr Metab Disord. Jun 2008;9(2):171-80. [Medline].

  10. Crook MA. Management of severe hypophosphatemia. Nutrition. Mar 2009;25(3):368-9. [Medline].

  11. Domrongkitchaiporn S, Disthabanchong S, Cheawchanthanakij R, Niticharoenpong K, Stitchantrakul W, Charoenphandhu N, et al. Oral Phosphate Supplementation Corrects Hypophosphatemia and Normalizes Plasma FGF23 and 25-Hydroxyvitamin D3 Levels in Women with Chronic Metabolic Acidosis. Exp Clin Endocrinol Diabetes. May 15 2009;[Medline].

  12. Fukumoto S. Physiological regulation and disorders of phosphate metabolism--pivotal role of fibroblast growth factor 23. Intern Med. 2008;47(5):337-43. [Medline].

  13. Ghosh AK, Joshi SR. Disorders of calcium, phosphorus and magnesium metabolism. J Assoc Physicians India. Aug 2008;56:613-21. [Medline].

  14. Juppner H. Novel regulators of phosphate homeostasis and bone metabolism. Ther Apher Dial. Oct 2007;11 Suppl 1:S3-22. [Medline].

  15. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. Jun 2008;35(2):215-37, v-vi. [Medline].

  16. Oud L. Transient hypoxic respiratory failure in a patient with severe hypophosphatemia. Med Sci Monit. Mar 2009;15(3):CS49-53. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.