Exam 1: Phosphorus Imbalances Flashcards
What does Phosphorus do?
Critical constituent of all body tissues. It is essential to the function of muscle and red blood cells; the formation of ATP, and 2-3 diphosphoglycerate which faciltates teh realse of oxygen from hemoglobin, and the maintenance of acid-base balance. AS well as intermeddiate metabolism of carbohydrate, protein, and fat
What structual suport does Phosphorus provide?
Provides structural support to bones and teeth.
Where is Phosphorus located?
85% in bones and teeth, 14% in soft tissue, and less than 1% in ECF
Normal Serum Phosphorus Level?
2.5-4.5 mg/dL
What does PTH do for Phosphorus?
Assists in phosphate homeostasis by varying phoshphate reabsorption in the proximal tubule of the kidney and allows the shift of phsophate from bone to plasma
Phosphorus Deficit name?
Hypophosphatemia
Phosphorus Excess Name?
Hyperphosphatemia
Hypophosphatemia Contributing Factors
Refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratory and metabolic alkalosis, decreased magnesium, decreased potassium, vitamin d deficency,
Hypophosphatemia Signs/Symptoms
Paresthesias, Muscle Weakness, Bone Pain and Tenderness, Chest Pain, Confusion, Respiratory Failure, Seizures , Nystagmus
Hyperphosphatemia Contributing Factors
Acute kidney injury and chronic kidney disease, excessive intake of phosphorus, vitamin d excess, volume depletion
Hyperphosphatemia Signs/Symptoms
Tetancy, Tachycardia, Anorexia, Muscle Weakness, Hypocalcemia, N/V,
When might phosphorus deficiency occur?
When abnormally low content of phosphorus in lean tissues that may exist in the absence of Hyperphosphatemia. May be caused by an intracellular shift of potassium from serum into cells, by increased urinary excretion of potassiun, or decreased intestinal absorption of potassium
Hyperphosphatemia: Pathophysiology
May occur during administration of calories to patietns with severe protein-calorie malnutrition. More result of overzealous intake or administration of simple carbohydrates
Other causes of Hyperphosphatemia
Heat Stroke, Prolonged Intesnse Hyperventilation, Alcohol Withdrawal, poor Dietery Intake, Diabetic Ketoacidosis, REspiratory Alkalosis
What do Low magnsium levels, low potassium levels, and hyperparathyroidism related to urinary losses of phosphorus lead to?
Hyperphosphatemia
Hyperphosphatemia: Hypoxia
Leads to an increase in respiratory rate and respiratory alkalosis, causing phosphorus to move into the cells and potentiating Hyperphosphatemia
When testing, what could caught a decrease in serum phosphorus level?
Glucose or Insulin Administration causes a slight decrease in this.
PTH levels in Hyperparathyroidism?
They are increased
Serum Magnesium in Hypophosphatemia?
It may decrease due to increased urinary excretion of magnesium
Hypophosphatemia: Medical Management
Patients at risk should have their serum phosphate levels closely monitored and correction initiated before deficits become severe
Hypophosphatemia: Medical Management: IV
usually limited for the patient whose serum phosphorus levels decrease to less than 1 mg/dL and whose GI tract is not functioning
Hypophosphatemia: Possible Effects from IV?
Tetany from Hypocalcemia and Calcifications in Tissues from Hyperphosphatemia.
What foods should be given for those with mild Hyperphosphatemia
Milk and milk products, organ meats, nuts, fish, poultry, and whole grains
Most common condition for Hyperphosphatemia
Kdiney injury .
Other causes of Hyperphosphatemia
Increased intrake, decreased output, or a shift from the itnracellular to rextracellular space
What other coniditions can lead to Hyperphosphatemia
Excessivce Vitamin D intake, administration of totral parenteral nutrition, chemotherapy, high phosphate intake, increased phosphorus.
Primary complicaiton with increased phosphorus?
Metastatic Calcification, which occurs when the calcium - magnesium product exceeds 70 mg / dL
High serum phosphorus levels tend to cause what for calcium?
Low serum calcium concentration
Major long term consequence of Hyperphosphatemia?
Soft Tissue Calcification, which occurs mainly in patients with reduced glomerilar filtration rate.
Phosphorus is the primary anion of what?
The ICF
Hyphosphatemia: ATP deficiency impairs
cellular energy resources
Hyphosphatemia: Diphosphoglycerate deficiency impairs
oxygen delivery to tissues, resulting in wide range of neurologic manifestations
Hyphosphatemia: What may develop as ATP level in the muscle tissue declines?
Muscle damage.
Hyphosphatemia: Clinical manifestations of muscle damage?
Muscle weakness, muscle pain, acute rhabdomyolysis. WEaknes of respiratory muscle greatly impair ventilation
Hyphosphatemia: What is prescribed for those with moderate Hyphosphatemia
Neutra-Phos capsules
K-Phos
Fleet PhospoSoda
Hyperphosphatemia: Most important short-term consequence is
tetany
Hyperphosphatemia: What is useful for diagnosing the primary disorder?
Serum calcium level.
Hyperphosphatemia: What test may show changes with abnormal bone development?
X-Ray
Hyperphosphatemia: PTH level?
Decreased in hypoparathyroidism
Hyperphosphatemia: BUN and Creatine levels are used to
assess renal function
Hyperphosphatemia: MEedical Treatment . Hyperphosphatemia may be related to
volume depletion or respiratory or metabolic acidosis
Hyperphosphatemia: MEdical management in kidney injury
Elevated PTH production contributes to high phosphorus level and bone disease
Measures to decrease and bind phosphorus to GI tract include Vitamin D prpeparation.
Hyperphosphatemia: Medical Management with IV
IV administration of Calcitriol does not increase serum calcium. Thus calcium-binding antacids can be used
Hyperphosphatemia: Medical Management - Restriction of
dietary phosphate, forced diuresis witha loop diruection , volume replace with saline,a and dialysis
Hyperphosphatemia: Surgery indicated for
removal of calcium and phosphorus deposits
Hyperphosphatemia: What foods should be avoided?
Hard Cheese Cream Nuts Meats Whole-GRain Cereals Dried Fruits/Veggies Kidney SArdines Sweetbreads Food made with milk
