||Bollaert PE, Levy B, Nace L,
Laterre PF, Larcan A. Hemodynamic and metabolic effects of rapid
correction of hypophosphatemia in patients with septic shock. Chest
||Charron T, Bernard F, Skrobik Y, Simoneau N, Gagnon N, Leblanc M. Intravenous phosphate in the intensive care unit: More aggressive repletion regimens for moderate and severe
hypophosphatemia. Intensive Care Med. 2003 Aug;29(8):1273-8. Epub 2003 Jul 05.
"In summary, ICU patients are prone to hypophosphatemia which can
lead to several physiological alterations in cell function. These
potential deleterious effects are reversed by phosphate
supplementation. Rapid correction of phosphate deficit, as
demonstrated here, appears safe. To prevent additional insult to
tissues from phosphate deficit and because phosphate infusion is
incompatible with many other medications we suggest infusing phosphate
in the following manner: 30 mmol potassium phosphate over 2 h or 45
mmol over 3 h in patients with a baseline serum potassium below 4.0
mmol/l and creatinine below 200 µmol/l. Slower protocols (i.e., 30
mmol potassium phosphate over 4 h or 45 mmol over 6 h) or sodium
phosphate (which is more expensive) are as efficacious and should be
favored if kalemia is a concern."
||Clark CL, Sacks GS, Dickerson
RN, Kudsk KA, Brown RO. Treatment of hypophosphatemia in patients
receiving specialized nutrition support using a graduated dosing
scheme: results from a prospective clinical trial. Crit Care Med 1995
||Kingston M, Al-Siba'i MB.
Treatment of severe hypophosphatemia. Crit Care Med 1985
"A 4-h infusion of 310 to 465 mg (10 to 15 mMol) phosphorus given
to 28 of 31 consecutive seriously ill hypophosphatemic patients
increased the serum phosphorus level above 1.2 mg/dl in all but one
patient. There was no significant change in the mean serum calcium,
potassium or blood pressure, no patient deteriorated, and six patients
were stronger and more alert after the infusion. In seriously ill
patients we recommend a 4-h infusion of 15 mg/kg (0.5 mMol/kg)
phosphorus if the serum phosphorus is less than 0.5 mg/dl, or a
7.7-mg/kg (0.25 mMol/kg) infusion if the serum phosphorus is between
0.5 and 1.0 mg/dl."
||Lentz, RD, Brown, DM,
Kjellstrand, CM. Treatment of severe hypophosphatemia. Ann Intern Med 1978; 89:941.
||Miller DW, Slovis CM.
Hypophosphatemia in the emergency department therapeutics. Am J Emerg
Med 2000 Jul;18(4):457-61.
"Severe hypophosphatemia, as defined by a serum level below 1.0
mg/dL, may cause acute respiratory failure, myocardial depression, or
Summary: Administering K2PO4 at a rate of 1 mL (3 mMol) per hour is almost always a very safe and appropriate treatment for
||Perreault MM, Ostrop NJ,
Tierney MG. Efficacy and safety of intravenous phosphate
replacement in critically ill patients. Ann Pharmacother 1997
" CONCLUSIONS: The administration of potassium phosphate 15 mmol to critically ill patients with mild-to-moderate hypophosphatemia over 3 hours is both effective and safe. The administration of potassium phosphate 30 mmol to severely hypophosphatemic patients was safe but achieved normalization of serum phosphate in a minority of patients. Either a higher dose or the subsequent administration of more potassium phosphate may be required to normalize serum phosphate concentrations. Once normalization has occurred, there is a high likelihood of redevelopment of hypophosphatemia over the following 2 days and supplementation should be given accordingly."
||Rosen GH, Boullata
O'Rangers EA, Enow NB, Shin B. Department of Pharmacy,
University of Maryland Medical System, Baltimore, USA. Intravenous
phosphate repletion regimen for critically ill patients with moderate
hypophosphatemia. Crit Care Med 1995 Jul;23(7):1204-10
||Schwartz A, Gurman G, Cohen G,
Gilutz H, Brill S, Schily M, Gurevitch B, Shoenfeld Y. Association
between hypophosphatemia and cardiac arrhythmias in the early stages
of sepsis. Eur J Intern Med 2002 Oct;13(7):434.
||Shiber JR, Mattu A. Serum phosphate abnormalities in the emergency department. J Emerg Med. 2002 Nov;23(4):395-400.
"Patients with severe or symptomatic hypophosphatemia should be treated with IV phosphate therapy (0.08-0.16 mg/kg over 6 h) and admitted for monitoring and subsequent serum electrolyte testing."
Khardori, R. Severe hypophosphatemia. Medicine 2000; 79:1.
||Wilson HK, Keuer SP, Lea AS,
Boyd AE 3rd, Eknoyan G. Phosphate therapy in diabetic ketoacidosis.
Arch Intern Med 1982 Mar;142(3):517-20
||Zazzo JF, Troche G, Ruel P,
Maintenant J. High incidence of hypophosphatemia in surgical intensive
care patients: efficacy of phosphorus therapy on myocardial function.
ntensive Care Med 1995 Oct;21(10):826-31.