Severe
hypophosphatemia is a potentially life-threatening medical condition and might lead to a fatal outcome in
critically ill patients. The situation is further complicated by the co-morbid
renal failure. We evaluated the efficacy and safety of the intravenous
phosphate repletion in 15
renal failure patients with severe
hypophosphatemia. Six patients with advanced
renal failure and nine patients under maintenance
hemodialysis, 7 males and 8 females, aged between 42 and 83 years old, were found to have serum
phosphate level < 1.2 mg/dL from various medical conditions and were treated with intravenous
phosphate infusion. The
phosphate solution prepared from
sodium dihydrogen phosphate (NaH2PO4), containing 13 mg/ml
phosphate and 0.5 meq/ml
sodium, in the dosage 2.5-3.0 mg
phosphate/Kg
body weight, was administered through the central venous lins every 6-8 hours. The infusion was discontinued once serum
phosphate level reached 5.0-5.5 mg/dL. Serum ionized
calcium, phosphate and intact
parathyroid hormone levels were serially followed at different intervals, respectively. The hemodialyzed uremic patients received their dialysis treatment as scheduled. All patients survived the hypophosphatemic period and regained normal
phosphate levels after repletion. The amount of
phosphate administered to reach the target level ranged between 3438 and 9150 mg and the
duration of treatment varied between six and seventeen days.
Hypocalcemia (< 4.2 mg/dL) was noted at eight occasions during the whole treatment period but none was symptomatic. Eleven patients recovered from the offending illness. However, four patients expired due to reasons not directly consequent to and temporally remote from
hypophosphatemia. We conclude that prompt repletion of severe
hypophosphatemia and
phosphate deficiency with relatively slower rate of NaH2PO4
solution intravenous infusion is a safe and effective mode of treatment for
renal failure and uremic patients. The longer treatment period allowed the administered minerals full equilibration. The risk of
hyperkalemia is avoided and the
sodium/volume load can be eliminated by dialysis.