Paulson - Phosphorus Flashcards
common acute causes of hyperphosphatemia
ARF
tumor lysis syndrome
acquired hypoparathyroidism → parathyroidectomy
chronic causes of hyperphosphatemia (3)
ckd!!!
hypoparathyroidism
pseudohypoparathyroidism
mc presentation of hyperphosphatemia
asymptomatic
sx of acute severe hyperphosphatemia are rt
hypocalcemia
sx of severe hyperphosphatemia
tetany
m. cramps
perioral numbness/tingling
sz
sx of hypocalcemia
sx of severe hyperphosphatemia
uremia
pruritis
sob
sleep disturances
painful masses around joints
skin ulcerations
irritated conjunctiva
ectopic calcifications
dx for hyperphosphatemia
serum phos → separate lab
pth
serum Ca
vit D
renal bx if suspect renal patho
tx for acute hyerphosphatemia w. normal renal fxn
saline
PLUS
loop diuretic
tx for hyperphosphatemia rt hypoparathyroidism
Ca
Vit D
tx for hyperphosphatemia rt aki
phosphate binders
when are phos binders rec for hyperphosphatemia
phos > 6
tx for severe/symptomatic hyperphosphatemia
dialysis
tx for hyperphosphatemia rt ckd (4)
start when levels above nl
restrict dietary sources
phos binders
dialysis
def of hypophosphatemia
phos < 2.5
causes of hypophosphatemia
respiratory alkalosis → phos from serum into intracellular space
sepsis
refeeding
etoh wd
hypercalcemia
hyperparathyroidism
vit D deficiency
lots!
when is hypophosphatemia symptomatic
phos < 1
rare
sx of hypophosphatemia
metabolic encephalopathy
proximal myopathy
impaired contractility
rhabdo
dysphagia
hemolysis
dx for hypophosphatemia
serum phos
urinary phos → 24 hr vs random
calculation for hypophos w. urine specimen
fractional excretion of filtered phos (FEPO4)
low FEPO4 indicates
low renal phos excretion → internal redistribution vs decreased intestinal absorptoin
elevated FEPO4 indicates
renal phos wasting →
hyperparathyroidism
vs
vit D deficiency
vs
renal tubular defect
tx for asymptomatic hypophosphatemia < 2.0
oral phos
tx for symptomatic hypophos 1.0-1.9
oral phos
tx for hypophos < 1.0
iv phos
then switch to po once serum phos > 1.5
indications for iv phos w. serum phos 1.0-1.9 (3)
rhabdo
CNS sx
hd
tx for uinary phos wasting
dipyridamole qid
more difficult to tx
