A total of 136 patients were included, with 68 patients in both the restricted phosphate group and unrestricted phosphate groups. 20mmol (20ml) in 500ml glucose 5% over 12 hours x 2. Possible symptoms include: weakness, anorexia, malaise, tremor, paraesthesia, seizures, acute respiratory failure, arrhythmias, altered mental status and hypotension. Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. Oral treatment can be provided using Phosphate Novartis® at the usual dose of 500 mg BID (each 500 mg effervescent tablet dissolved in water provides the equivalent of 16 mmol of phosphate, 3 mmol of potassium and 20 mmol of sodium). Oral/Enteral Electrolyte Replacement . Select the form of phosphate, the dose in mmol, Phosphate level <0.3mmol/L and patient has impaired renal function: Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. If the patient is requiring concentrated intravenous phosphate replacement whilst on total parental nutrition please refer to Prince of Wales Hospital clinical business rule Phosphate replacement in patients receiving Total Parenteral Nutrition. MD. Please scan to Pharmacy As Soon As Possible. For oral dosage forms (powder for oral solution): To replace phosphorus lost by the body: Adults, teenagers, and children over 4 years of age—The equivalent of 250 mg of phosphorus dissolved in two and one-half ounces of water four times a day, after meals and at bedtime. Symptoms occur when the serum phosphate concentration is less than 2 mg/dL (0.64 mmol/L). equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], equivalent to elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit flavor], Brands of combined preparations of Sodium Phosphate and Potassium Phosphate. Phosphate 0.6-0.8 mmol/l – repeat serum levels at next routine test (2-3 days) unless symptomatic.. Potassium phosphate may also be used if potassium is low. In assumption of systemic phosphorus depletion, the presumed deficit commonly is replaced by oral phosphate supplements. Phosphate can be given in doses up to about 1 g orally 3 times a day in tablets containing sodium phosphate or potassium phosphate. (consider oral). Children up to 4 years of age—Dose must be determined by your doctor. Check serum phosphate levels every 6hours when giving IV phosphate. They also contain: Phosphate Sandoz ® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 times/day after meals and at bedtime. Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. Patients who may require brain stem death testing should have their phosphate maintained above 0.5 mmol/l using Polyfusor Oral administration Dissolve 1 tablet (16.1 mmol) in 16 ml of water giving a 1 mmol/ml solution. Repeat the dose within 24 hours if an adequate level (>0.64mmol/L) has not been achieved. Avoid doses in excess of 0.24 mmol/kg if possible; Use slower rates of replacement (0.08 to 0.20 mmol/kg) especially if more recent Hypophosphatemia onset; Risk of precipitating calcium, with secondary Hypocalcemia, Acute Renal Failure and Arrhythmias 1.3 to 1.4 mmol/kg of elemental phosphorus (up to a maximum of 100 mmol) can be given in three to four divided doses over a 24-hour period. For patients who are symptomatic and have a serum phosphate level less than 1.0 mg/dL, IV replacement is recommended, followed by oral replacement once serum phosphate levels reach greater than 1.5 mg/dL. phosphate, Ca2+, K+, Mg2+ ECG; MANAGEMENT. Serum Phosphate <1.0 mg/dl; Switch to oral replacement when Serum Phosphate >1.5 mg/dl; Precautions. High doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. Phosphate level <0.3mmol/L and patient has normal renal function: Sodium glycerophosphate 21.6% IV 40mmol given as 2 x 12 hour infusions, i.e. Each carton contains 5 tubes of 20 tablets. Administration: Phosphate Sandoz Effervescent Tablets: Dissolve one tablet in 16mL of water to give a 1mmol/mL suspension, use the required amount and dispose of any remaining solution. per dose 50 mmol), increased dose to be used in critically ill patients; dose to be infused over 6–12 hours, according to … The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. (Conversion: 3 mmols KPO4 = 4.4 mEq K+), From: http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf, The Washington Manual of Medical Therapeutics, Designed by Elegant Themes | Powered by WordPress. If the level gets to 1.5 mg/dL, switch to oral treatment if possible. Critical Care . For oral dosage forms (powder for oral solution): To replace phosphorus lost by the body: Adults, teenagers, and children over 4 years of age—The equivalent of 250 mg of phosphorus dissolved in two and one-half ounces of water four times a day, after meals and at bedtime. Our hospital’s reference range for phosphate is 0.85–1.45 mmol/L. The average patient requires 1000-2000 mg (32-64 mmol) of phosphate per day for 7-10 days to replenish the body stores. Phos NaK 250-500 mg 1 … 1,2 Intravenous (IV) phosphate replacement carries many potential side effects and is therefore given for severe hypophosphataemia (<0.3 mmol/L) only. Oral phosphate replacement . The rate and amount of replacement are empirically determined, and several algorithms are available. Had a wrist operation yesterday . A serum phosphate level of less than 2.8 mg/dL defines hypophosphatemia. Phosphate is the drug form (salt) of phosphorus. Introduction. Oral Administration: • Applies to patients with magnesium level > 1.5 mg/dL who are asymptomatic and able to tolerate PO or PT meds. Serum phosphate (reference range 0.7-1.4mmol/L). Regardless of whether replacement is given repeat serum phosphate, U&E, Mg2+ Ca2+ and Albumin next day. For mild deficiency (phosphate 0.5-0.8 mmol/L) oral therapy is safer and should be used wherever possible. Suggest dosage for Codeine Phosphate . Decide which phosphate salt should be administered. Separate order must be entered into Wiz/HEO for oral replacement. Ingredients. Notify MD 30 mmol KPO4 IV* 6 hours after replacement 1.6 - 1.9 mg/dl 30 mmol KPO4 IV*, or Na/K phos** - 1 package by mouth every 6 hours x … Hypotension, hyperphosphataemia, hypocalcaemia, hypernatraemia, dehydration and metastatic calcification are possible adverse effects of intravenous phosphate therapy. Premium Questions. PHOSPHATE If K less than or equal to 4.0 mEq/L (Normal range 2.5 - 4.7 mg/dl) Serum Phosphorus Replace with Recheck level less than 1.6 mg/dl. Treatment aimed at the cause is recommended for all levels of hypophosphatemia. Separate order must be entered into EPIC for oral replacement. only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. It is recommended that severe hypophosphataemia be treated intravenously as large doses of oral phosphate may cause diarrhoea; intestinal absorption may be unreliable and dose adjustment may be necessary. However, such treatment is debatable, because … Established hypophosphataemia (with monobasic potassium phosphate) By intravenous infusion. When a treatable cause of the hypophosphatemia is known, then treatment of that underlying cause is of paramount importance and is often curative. E.g replace vitamin D in patients with vitamin D deficiency. The 20ml solution contains 20mmol phosphate (1mmol/ml) and 40mmol sodium (2mmol/ml). Oral phosphate replacement In moderate hypophosphataemia, phosphate may be replaced by increasing the dietary intake of dairy product and other foods high in phosphate (on the advice of a dietician). Because of that, most hypophosphatemic patients will not require phosphate replacement unless their Phosphate level is less than 2. 250mg = 8.06 mmol. Serum phosphate, potassium, calcium and magnesium levels should be monitored every 12-24 hours during IV phosphate administration. • Use SODIUM phosphate for patients with serum potassium > 4.5 mEq/L and serum sodium < 145mEq/L. Oral replacement with KCl (mainstay) Potassium phosphate (PO/IV) o Appropriate in pxs with combined hypokalemia and hypophosphatemia Potassium bicarbonate or potassium citrate o For pxs with concomitant metabolic acidosis Hypomagnesemic pxs o Refractory to K replacement alone Potassium phosphate (PO/IV) o Appropriate in pxs with combined How to prescribe: Prescribe on eMeds using the paediatric - oral electrolyte replacement - phosphate protocol. E.g. Standard Phosphorous (PO 4) Replacement Protocol (For All Patient Types and All Units) MEDITECH Standard Protocol IMPORTANT: Pharmacy must receive a copy of all medication orders (new & change orders). Potassium Phosphate 15 or 30 mmol IV over 4-6hrs can also be used to replace phosphorus IV if potassium is also low as well. It’s diluted in 250 ml of Normal saline. Medical care for hypophosphatemia is highly dependent on three factors: cause, severity, and duration. PATIENT Because of that, only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. K-Phos 1-2 tabs PO QID. feed adequately (caution in refeeding syndrome) if phosphate 0.65-0.89 give oral phosphate; IV phosphate:-> KH 2 PO 4 – 10mmol of phosphate and 10mmol of K in 10mL-> NaKH 2 PO 4 – 13.4mmol of phosphate, 21.4mmol Na+, 2.6mmol K in 20mL. 1 tab of K-phos = 250 mg phosphorus, 8 mmol phosphate, 1.1 mEq potassium, 13 mEq sodium. Phosphate Sandoz ® contains sodium dihydrogen phosphate anhydrous (anhydrous sodium acid phosphate) 1.936 g, sodium bicarbonate 350 mg, potassium bicarbonate 315 mg, equivalent to phosphorus 500 mg (phosphate 16.1 mmol), sodium 468.8 mg (Na + 20.4 mmol), potassium 123 mg (K + 3.1 mmol); Polyfusor NA ® contains Na + 162 mmol/litre, K + 19 mmol/litre, PO 4 3-100 mmol/litre; non … 9 mmol every 12 hours, increased if necessary up to 0.5 mmol/kg (max. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Phosphate Sandoz effervescent tablets are large, white, flat, circular tablets with a slightly rough surface. The dose should be reviewed daily according to phosphate levels. Stop IV repletion when the serum phosphate level is > 1.5 mg/dL and when oral therapy is possible. o Potassium Phosphate: 15 mmol/250 mL and 21 mmol/250 mL o Sodium Phosphate: 15 mmol/250 mL, 21 mmol/250 mL, and 30 mmol/250 mL Current Serum Phosphorus Level Total Phosphorus Replacement Monitoring 2 – 2.5 mg/dL 15 mmol Potassium Phosphate IV over 4 HR No additional action 1 – 1.9 mg/dL 21 mmol Potassium Phosphate IV over 4 HR Phosphorus: (hypophosphatemia) : -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. Orders Standard Phosphorus Replacement Target PO 4 Level: Greater than or equal to 2.5 mg/dL Phos NaK 250-500 mg 1 tab four times a day with meals and at bedtime. Round the total dose calculated to the closest preparation dose available (e.g., typically 7.5 mmol for IV, 8 mmol for PO). Sodium phosphate is preferred for intravenous therapy. Phosphate - Sandoz effervescent tablets contain elemental phosphorous 500 mg, present as sodium phosphate monobasic. Diarrhoea is a common side effect of oral phosphate therapy and may necessitate a reduction in dose. It is potentially dangerous because it can precipitate with calcium and cause hypocalcemia (because the phosphate binds to calcium), renal failure (due to calcium phosphate precipitation in the kidneys), and possibly fatal arrhythmias. Management of Phosphate administration Description Oral preparation: Phosphate Phebra effervescent tablet: 16.1 mmol per tablet Prescription For oral supplementation, charted on prescription chart stating dose in mmol, frequency, and mmol/kg/day. Follow your doctor's orders or the directions on the label. • Phosphate replacement must be ordered in mmol of phosphorus. Results. 1 mmol/kg of elemental phosphorus (minimum of 40 mmol and a maximum of 80 mmol) can be given in 3 to 4 divided doses over a 24-hour period. Phosphates are used as dietary supplements for patients who are unable to get enough phosphorus in their regular diet, usually because of certain illnesses or diseases. Oral replacement is generally adequate for mild and moderate hypophosphataemia >0.3 mmol/L). NB. Phosphate Summary: Phosphorus: (hypophosphatemia): -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). Hypophosphatemia caused by renal phosphate loss occurs frequently after kidney transplantation. Potassium Phosphate: 15 mmol/250 mL and 21 mmol/250 mL. Brands of combined preparations of Sodium Phosphate and Potassium Phosphate used for oral phosphate replacement. Hypophosphataemia may be asymptomatic, but clinical symptoms usually become apparent when plasma phosphate concentrations fall below 0.3mmol/L. Exclusions: Renal insufficiency (SCr >2 and/or CrCl < 20 mg/dL), Rhabdomyolysis, DKA, Weight < 50 kg *** Consider oral/enteral replacement if GI tract available *** *** Oral/enteral replacement is preferred in asymptomatic patients *** Considering that the normal adult intake of phosphate is about 35 mmol per day, a reasonable typical IV replacement is 20-40mmol per day. The dose medicines in this class will be different for different patients.