How is hypophosphatemia treated

How is hypophosphatemia treated?

Moderate hypophosphatemia (phosphorus >1 mg/dL, 0.32 mmol/L) and asymptomatic patients can be treated with oral phosphate. Cow’s milk is a good source of phosphate. Typical oral dosing is 40 to 80 mmol (124 to 248 mg) divided into four doses over 24 hours. Severe hypophosphatemia (<1 mg/dL, 0.32 mmol/L) and patients who cannot tolerate oral replacement need intravenous (IV) replacement. IV phosphorus can cause hypocalcemia, kidney failure, hypotension, hyperphosphatemia, and electrocardiogram (ECG) abnormalities. These complications can be avoided with moderate doses. A safe dose is considered to be 15 mmol over 2 hours; however, doses graded by weight and phosphorus level were shown to be more effective and just as safe in a prospective trial.

This protocol corrected 78% of patients with hypophosphatemia with a single dose administered over 6 hours (compared to 47% prior to the protocol) and resulted in no cases of hyperphosphatemia (compared to 16 episodes prior to the protocol).

Phosphorus Treatment ProtocolFrom Taylor, B. E., Huey, W. Y., Buchman, T. G., Boyle, W. A., & Coopersmith, C. M. (2004). Treatment of hypophosphatemia using a protocol based on patient weight and serum phosphorus level in a surgical intensive care unit. Journal of the American College of Surgeons, 198 (2), 198–204.

Phosphorus LevelWeight
mmol/lmg/dl40–60 kg61–80 kg81–120 kg
<0.321.030 mmol Phos40 mmol Phos50 mmol Phos
0.32–0.541.0–1.720 mmol Phos30 mmol Phos40 mmol Phos
0.55–0.701.7–2.210 mmol Phos15 mmol Phos20 mmol Phos
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