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

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