Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial.

Abstract

OBJECTIVE:

To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support.

DESIGN:

Prospective clinical trial.

SETTING:

A 455-bed tertiary care institution, with Level I trauma designation.

PATIENTS:

Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of < 3 mg/dL (< 0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity.

INTERVENTIONS:

Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (< 1.5 mg/dL [< 0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days.

MEASUREMENTS AND MAIN RESULTS:

Sixty-seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 +/- 0.6 to 3.3 +/- 0.6 mg/dL (0.84 +/- 0.19 to 1.1 +/- 0.19 mmol/L) for the mild group; 1.9 +/- 0.6 to 2.7 +/- 0.6 mg/dL (0.61 +/- 0.19 to 0.87 +/- 0.19 mmol/L) for the moderate group; 1.3 +/- 0.8 to 2.3 +/- 0.8 mg/dL (0.42 +/- 0.26 to 0.74 +/- 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period.

CONCLUSION:

The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.

• Authors: C L Clark, G S Sacks, R N Dickerson, K A Kudsk, R O Brown
• Journal: Critical care medicine (Crit Care Med) Vol. 23 Issue 9 Pg. 1504-11 (Sep 1995) ISSN: 0090-3493 [Print] United States
• PMID: 7664552 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Electrolytes
• Phosphorus

Topics

• Adult
• Blood Urea Nitrogen
• Critical Care
• Dose-Response Relationship, Drug
• Electrolytes (blood)
• Enteral Nutrition
• Female
• Humans
• Hypophosphatemia (drug therapy, etiology)
• Male
• Middle Aged
• Parenteral Nutrition
• Phosphorus (administration & dosage)
• Prospective Studies
• Severity of Illness Index
• Wounds and Injuries (complications)