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Intravenous phosphate in the intensive care unit: more aggressive repletion regimens for moderate and severe hypophosphatemia.

AbstractOBJECTIVE:
To evaluate efficacy and safety of aggressive correction of hypophosphatemia with intravenous potassium phosphate in the ICU.
DESIGN AND SETTING:
Randomized interventional prospective study in the medical and surgical ICU of a tertiary university hospital.
PATIENTS:
Critically ill patients with hypophosphatemia between June and November 1998.
MEASUREMENTS AND RESULTS:
Patients with moderate hypophosphatemia (<0.65 and >0.40 mmol/l; n=37) were randomized into two groups: group 1 received 30 mmol potassium phosphate intravenously in 50 ml saline over 2 h, and group 2 received 30 mmol potassium phosphate in 100 ml saline over 4 h. Patients with severe hypophosphatemia (<0.40 mmol/l; n=10) were also randomized into two groups: group 3 received 45 mmol potassium phosphate intravenously in 100 ml saline over 3 h, and group 4 received 45 mmol potassium phosphate in 100 ml saline over 6 h. Electrolytes, blood gas, renal function were monitored until day 3; urine was collected during and until 6 h after infusions. The overall efficacy of the protocols was 98% by the end of the infusion. There was no statistical difference in phosphate values between groups at the end of infusion or at 24 h. No adverse events were noted; one patient had an increase in serum potassium to 6.1 mmol/l. Phosphaturia in all groups was elevated as evidenced by fractional excretion above 20%.
CONCLUSIONS:
More rapid administration of large potassium phosphate boluses is effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function if baseline serum potassium is below 4 mmol/l.
AuthorsThierry Charron, Francis Bernard, Yoanna Skrobik, Nathalie Simoneau, Nadine Gagnon, Martine Leblanc
JournalIntensive care medicine (Intensive Care Med) Vol. 29 Issue 8 Pg. 1273-8 (Aug 2003) ISSN: 0342-4642 [Print] United States
PMID12845429 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Phosphates
  • Potassium Compounds
  • potassium phosphate
Topics
  • Aged
  • Female
  • Humans
  • Hypophosphatemia (drug therapy, physiopathology)
  • Infusion Pumps
  • Intensive Care Units
  • Male
  • Middle Aged
  • Phosphates (administration & dosage, therapeutic use)
  • Potassium Compounds (administration & dosage, therapeutic use)
  • Prospective Studies
  • Treatment Outcome

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