Paulson - Phosphorus

Question 1

common acute causes of hyperphosphatemia

Answer 1

ARF

tumor lysis syndrome

acquired hypoparathyroidism → parathyroidectomy

Question 2

chronic causes of hyperphosphatemia (3)

Answer 2

ckd!!!

hypoparathyroidism

pseudohypoparathyroidism

Question 3

mc presentation of hyperphosphatemia

Answer 3

asymptomatic

Question 4

sx of acute severe hyperphosphatemia are rt

Answer 4

hypocalcemia

Question 5

sx of severe hyperphosphatemia

Answer 5

tetany

m. cramps

perioral numbness/tingling

sz

sx of hypocalcemia

Question 6

sx of severe hyperphosphatemia

Answer 6

uremia

pruritis

sob

sleep disturances

painful masses around joints

skin ulcerations

irritated conjunctiva

ectopic calcifications

Question 7

dx for hyperphosphatemia

Answer 7

serum phos → separate lab

pth

serum Ca

vit D

renal bx if suspect renal patho

Question 8

tx for acute hyerphosphatemia w. normal renal fxn

Answer 8

saline

PLUS

loop diuretic

Question 9

tx for hyperphosphatemia rt hypoparathyroidism

Answer 9

Ca

Vit D

Question 10

tx for hyperphosphatemia rt aki

Answer 10

phosphate binders

Question 11

when are phos binders rec for hyperphosphatemia

Answer 11

phos > 6

Question 12

tx for severe/symptomatic hyperphosphatemia

Answer 12

dialysis

Question 13

tx for hyperphosphatemia rt ckd (4)

Answer 13

start when levels above nl

restrict dietary sources

phos binders

dialysis

Question 14

def of hypophosphatemia

Answer 14

phos < 2.5

Question 15

causes of hypophosphatemia

Answer 15

respiratory alkalosis → phos from serum into intracellular space

sepsis

refeeding

etoh wd

hypercalcemia

hyperparathyroidism

vit D deficiency

lots!

Question 16

when is hypophosphatemia symptomatic

Answer 16

phos < 1

rare

Question 17

sx of hypophosphatemia

Answer 17

metabolic encephalopathy

proximal myopathy

impaired contractility

rhabdo

dysphagia

hemolysis

Question 18

dx for hypophosphatemia

Answer 18

serum phos

urinary phos → 24 hr vs random

Question 19

calculation for hypophos w. urine specimen

Answer 19

fractional excretion of filtered phos (FEPO4)

Question 20

low FEPO4 indicates

Answer 20

low renal phos excretion → internal redistribution vs decreased intestinal absorptoin

Question 21

elevated FEPO4 indicates

Answer 21

renal phos wasting →

hyperparathyroidism

vs

vit D deficiency

vs

renal tubular defect

Question 22

tx for asymptomatic hypophosphatemia < 2.0

Answer 22

oral phos

Question 23

tx for symptomatic hypophos 1.0-1.9

Answer 23

oral phos

Question 24

tx for hypophos < 1.0

Answer 24

iv phos

then switch to po once serum phos > 1.5

Question 25

indications for iv phos w. serum phos 1.0-1.9 (3)

Answer 25

rhabdo

CNS sx

hd

Question 26

tx for uinary phos wasting

Answer 26

dipyridamole qid

more difficult to tx