HYPOPHOSPHATAEMIA IN ICUs🌀

🔹Normal range (2.5-4.5 mg/dL),

🔹Plasma phosphate concentration < 2.5 mg/dL or 0.81 mmol/L

CAUSES:

🔹Poor Nutrition

🔹Chronic Alcoholism

🔹Diarrhoea

🔹Beta 2 Agonists

🔹Insulin 

🔹Acetazolamide

🔹Hemodialysis 

🔹Hyperparathyroidism

EFFECTS

🔹Irritability 

🔹Confusion

🔹Metabolic encephalopathy 

🔹Coma

🔹Muscle weakness 

🔹Respiratory failure

🔹Failure to wean from ventilator

🔹Dysphagia

🔹Ileus

🔹cardiac arrhythmias and cardiomyopathy.

🔹ODC shift to left

TREATMENT

🔹Asymptomatic mild-to-moderate hypophosphatemia (1-2.5 mg/dL) can be treated with oral phosphate supplementation if the gastrointestinal tract is intact. 

🔹Symptomatic or severe hypophosphatemia (< 1.0 mg/dL) should be treated with intravenous phosphate.

🔹Oral supplementation : 2.5 to 3.5 g (80 to 110 mmol) per day, divided over two to three doses.

Intravenous:

🔹The required dose of initial intravenous phosphate may vary from 2.5 to 19.8 mg/kg.

Typically, 2-5 mg/kg of inorganic phosphate dissolved in 0.45% saline is given over 6-12 hours and repeated as needed.

🔹Rapid or large infusions are dangerous : Large intravenous doses of phosphate may result in hyperphosphatemia, hypomagnesemia, hypocalcemia, and hypotension.

🔹Hyperkalemia is prevented by using sodium phosphate instead of potassium phosphate in patients with potassium levels >4 mmol/L.

🔹Do not mix with Calcium or Magnesium

🔹Daily Phosphate level monitoring should be done

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