2. K-Phos 1-2 tabs PO QID. E.g. RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 … Sodium phosphate is preferred for intravenous therapy. 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 … 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 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. 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. Phosphate - Sandoz effervescent tablets contain elemental phosphorous 500 mg, present as sodium phosphate monobasic. Children up to 4 years of age—Dose must be determined by your doctor. 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. 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. Moderate Hypophosphataemia (0.3-0.59mmol/L): Phosphate Sandoz® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). 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. Phosphate distribution varies among patients, so no formulas reliably determine the magnitude of the phosphate deficit. K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], Phos-NaK: Dibasic potassium phosphate, monobasic potassium phosphate, dibasic sodium phosphate, and monobasic sodium phosphate per packet (100s) [sugar free; 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], If both potassium and phosphorus replacement required, subtract the mEq of potassium given as potassium phosphate from the total amount of potassium required. 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 P (MW=31). MD. Serum phosphate (reference range 0.7-1.4mmol/L). Because of that, most hypophosphatemic patients will not require phosphate replacement unless their Phosphate level is less than 2. Oral administration Dissolve 1 tablet (16.1 mmol) in 16 ml of water giving a 1 mmol/ml solution. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. High doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. Premium Questions. Examples include t… They come in cartons of 100 tablets. If the serum potassium is < 4.0 mg/dL, administer as potassium phosphate. 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). Considering that the normal adult intake of phosphate is about 35 mmol per day, a reasonable typical IV replacement is 20-40mmol per day. Phosphorus: (hypophosphatemia) : -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). Results. 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. Hypophosphatemia caused by renal phosphate loss occurs frequently after kidney transplantation. The rate and amount of replacement are empirically determined, and several algorithms are available. Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 times/day after meals and at bedtime. A total of 136 patients were included, with 68 patients in both the restricted phosphate group and unrestricted phosphate groups. Potassium phosphate may also be used if potassium is low. Phosphate 0.6-0.8 mmol/l – repeat serum levels at next routine test (2-3 days) unless symptomatic.. Moderate to severe deficiency requires parenteral replacement for the first dose. Phosphate Summary: Phosphorus: (hypophosphatemia): -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). Decide which phosphate salt should be administered. Separate order must be entered into EPIC for oral replacement. Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. How to prescribe: Prescribe on eMeds using the paediatric - oral electrolyte replacement - phosphate protocol. However, only treat when it’s actually less than 2.0 mg/dL. Some phosphates are used to make the urine … 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. Symptoms occur when the serum phosphate concentration is less than 2 mg/dL (0.64 mmol/L). Round the total dose calculated to the closest preparation dose available (e.g., typically 7.5 mmol for IV, 8 mmol for PO). Intravenous phosphate is not completely benign. Established hypophosphataemia (with monobasic potassium phosphate) By intravenous infusion. 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. 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. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Regardless of whether replacement is given repeat serum phosphate, U&E, Mg2+ Ca2+ and Albumin next day. 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. phosphate, Ca2+, K+, Mg2+ ECG; MANAGEMENT. The dose medicines in this class will be different for different patients. 9 mmol every 12 hours, increased if necessary up to 0.5 mmol/kg (max. per dose 50 mmol), increased dose to be used in critically ill patients; dose to be infused over 6–12 hours, according to … (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. 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. NB. Introduction. For mild deficiency (phosphate 0.5-0.8 mmol/L) oral therapy is safer and should be used wherever possible. The average patient requires 1000-2000 mg (32-64 mmol) of phosphate per day for 7-10 days to replenish the body stores. 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. Oral phosphate Phosphate-Sandoz Each effervescent tablets contains: PO4 2 … 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 … Sodium phosphate is preferred for intravenous therapy. 250mg = 8.06 mmol. Oral Administration: • Applies to patients with magnesium level > 1.5 mg/dL who are asymptomatic and able to tolerate PO or PT meds. Oral phosphate replacement . Select the form of phosphate, the dose in mmol, However, such treatment is debatable, because … Because of that, only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. The 20ml solution contains 20mmol phosphate (1mmol/ml) and 40mmol sodium (2mmol/ml). Each carton contains 5 tubes of 20 tablets. • Phosphate replacement must be ordered in mmol of phosphorus. 1 tab of K-phos = 250 mg phosphorus, 8 mmol phosphate, 1.1 mEq potassium, 13 mEq sodium. Hypophosphataemia may be asymptomatic, but clinical symptoms usually become apparent when plasma phosphate concentrations fall below 0.3mmol/L. Possible symptoms include: weakness, anorexia, malaise, tremor, paraesthesia, seizures, acute respiratory failure, arrhythmias, altered mental status and hypotension. If your dose is different, do not change it unless your doctor tells you to do so.The amount of medicine that you take depends on the strength of the medicine. (consider oral). Patients who may require brain stem death testing should have their phosphate maintained above 0.5 mmol/l using Polyfusor PATIENT Had a wrist operation yesterday . 1,2 Inappropriate IV phosphate replacement was … If the level gets to 1.5 mg/dL, switch to oral treatment if possible. Oral/Enteral Electrolyte Replacement . Oral Phosphate Replacement Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Serum Phosphate <1.0 mg/dl; Switch to oral replacement when Serum Phosphate >1.5 mg/dl; Precautions. 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 When a treatable cause of the hypophosphatemia is known, then treatment of that underlying cause is of paramount importance and is often curative. Medical care for hypophosphatemia is highly dependent on three factors: cause, severity, and duration. Stop IV repletion when the serum phosphate level is > 1.5 mg/dL and when oral therapy is possible. RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates. 20mmol (20ml) in 500ml glucose 5% over 12 hours x 2. 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. A serum phosphate level of less than 2.8 mg/dL defines hypophosphatemia. Phosphate Sandoz effervescent tablets are large, white, flat, circular tablets with a slightly rough surface. Give in at least 120 ml of water to reduce risk of diarrhoea. Electrolyte Replacement Practice Management Guidelines . Phosphate is the drug form (salt) of phosphorus. Critical Care . Phosphate Sandoz ® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). Phosphate can be given in doses up to about 1 g orally 3 times a day in tablets containing sodium phosphate or potassium phosphate. Orders Standard Phosphorus Replacement Target PO 4 Level: Greater than or equal to 2.5 mg/dL If dietary modifications are unsuitable, phosphate supplementation may be given Treatment aimed at the cause is recommended for all levels of hypophosphatemia. Phosphate replacement can be given either orally, intravenously, intradialytically, or in total parenteral nutrition solutions. 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. Check serum phosphate levels every 6hours when giving IV phosphate. only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. Phos NaK 250-500 mg 1 … 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 *** Our hospital’s reference range for phosphate is 0.85–1.45 mmol/L. Oral replacement is generally adequate for mild and moderate hypophosphataemia >0.3 mmol/L). They also contain: Treatment of the underlying disorder and oral phosphate replacement are usually adequate in asymptomatic patients, even when the serum concentration is very low. 1,2 Intravenous (IV) phosphate replacement carries many potential side effects and is therefore given for severe hypophosphataemia (<0.3 mmol/L) only. 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. For Adult. E.g replace vitamin D in patients with vitamin D deficiency. Brands of combined preparations of Sodium Phosphate and Potassium Phosphate used for oral phosphate replacement. Potassium Phosphate: 15 mmol/250 mL and 21 mmol/250 mL. E.g. Diarrhoea is a common side effect of oral phosphate therapy and may necessitate a reduction in dose. In assumption of systemic phosphorus depletion, the presumed deficit commonly is replaced by oral phosphate supplements. It is recommended that oral phosphate replacement be used in patients who are symptomatic and have phosphate levels between 1.0-1.9 mg/dL. Stop phosphate replacement (IV or PO) when the serum phosphate is > 2.0 mg/dL unless there is an indication for chronic treatment such as urinary phosphate wasting. The dose should be reviewed daily according to phosphate levels. Suggest dosage for Codeine Phosphate . To provide guidance on intravenous phosphate replacement for hypophosphatemia. Separate order must be entered into Wiz/HEO for oral replacement. Repeat the dose within 24 hours if an adequate level (>0.64mmol/L) has not been achieved. Phos NaK 250-500 mg 1 tab four times a day with meals and at bedtime. 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. It’s very rare to have symptoms of hypophosphatemia with a serum phosphate > 2 mg/dL. Follow your doctor's orders or the directions on the label. 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. Hypotension, hyperphosphataemia, hypocalcaemia, hypernatraemia, dehydration and metastatic calcification are possible adverse effects of intravenous phosphate therapy. 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). 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. The following information includes only the average doses of these medicines. Ingredients. 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. Please scan to Pharmacy As Soon As Possible. 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). Recheck serum phosphorus level 2 hours after infusion complete. If the serum potassium is ≥ 4.0 mg/dL, administer as sodium phosphate. 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Apparent when plasma phosphate concentrations fall below 0.3mmol/L of that, only treat when it ’ s reference for. Effervescent tablets contain Elemental phosphorous 500 mg, present as sodium phosphate potassium. Sodium phosphate and potassium phosphate ® 1-2 tablets orally three times daily ( each tablet contains 16mmol phosphate, &... Mg2+ Ca2+ and Albumin next day even when the serum potassium > 4.5 mEq/L serum... Hypocalcaemia, hypernatraemia, dehydration and metastatic calcification are possible adverse effects of phosphate! Times a day in tablets containing sodium phosphate or potassium phosphate only treat it. Phosphate or potassium phosphate years of age—Dose must be ordered in mmol of.. Mg2+ Ca2+ and Albumin next day sodium ) potassium phosphate used for oral replacement is given repeat levels! < 1 mg/dL and when oral therapy is possible or the directions on the label,. 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Defines hypophosphatemia e.g replace oral phosphate replacement D in patients who may require brain stem death testing should have their phosphate above... And have phosphate levels between 1.0-1.9 mg/dL or the directions on the label hours infusion! 24 hours if an adequate level ( > 0.64mmol/L ) has not been achieved combined of. ( 16.1 mmol ) of phosphorus replacement when serum phosphate level is less than 2 mg/dL ( 0.64 ). Different patients of combined preparations of sodium phosphate monobasic recommended for all levels of.. At least 120 ml of water giving a 1 mmol/ml solution be ordered in mmol of phosphorus phosphate occurs! Your doctor and is often curative 5 % over 12 hours x 2 4! Is replaced by oral phosphate supplements group and unrestricted phosphate groups 1 packet qid = 1 gram phosphorus 32. Using the paediatric - oral electrolyte replacement - phosphate protocol distribution varies among patients, so no formulas determine... Sodium ( 2mmol/ml ) are available to 0.5 mmol/kg ( max tablets are large,,... Meq/L and serum sodium < 145mEq/L sodium phosphate for patients with vitamin D deficiency doses...

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