Phosphate Balance Flashcards

1
Q

What is the normal phosphate level?

A

The normal range for phosphorus is 2.7 to 4.5 mg/dL. The
symptoms of paresthesias, myopathy, delirium, seizures, and
coma correspond to hypophosphatemia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does respiratory alkalosis affect the renal

excretion of phosphate?

A

Respiratory alkalosis decreases the renal excretion of
phosphate.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does fluid volume expansion affect the renal

excretion of phosphate?

A

Volume expansion increases the renal excretion of phosphate.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three primary factors that influence the

renal reabsorption of phosphate by the kidneys?

A

Dietary intake, parathyroid hormone, and insulin-like growth
factor.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the majority of the body’s phosphorus

located?

A

About 90% of the body’s phosphorus is found in bone. Almost
10% is located in the intracellular fluid. The <1% remaining is
found in the extracellular fluid.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a potential effect of administering phosphate

to patients who are hypocalcemic?

A

The administration of phosphate to hypocalcemic patients could
exacerbate the hypocalcemia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does hyperventilation affect the phosphate

level?

A

Respiratory alkalosis from hyperventilation decreases
phosphate levels. Respiratory alkalosis is also presumed to be
the cause of hypophosphatemia associated with gram-negative
sepsis and salicylate poisoning.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 355-356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is ‘refeeding syndrome’?

A

Carbohydrate loading can induce hypophosphatemia via an
insulin-mediated uptake of phosphorus. This is the most
common form of hypophosphatemia seen in hospitalized
patients.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does hypophosphatemia affect hematologic

function?

A

Hypophosphatemia results in dysfunction of red and white blood
cells as well as platelets. Because the phagocytic, chemotaxic,
and bactericidal activity of the white blood cells is diminished,
hypophosphatemia can contribute to a patient’s susceptibility to
sepsis.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the neurologic symptoms of

hypophosphatemia?

A

Paresthesias, myopathy and, encephalopathy.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1134-1135.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is hyperphosphatemia treated in patients with

renal failure?

A

Limited phosphate intake and aluminum hydroxide ingestion
can help ameliorate hyperphosphatemia, but dialysis is the
most effective method for treating it quickly.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is hyperphosphatemia treated in patients

without renal failure?

A

The cause of the elevated phosphate level should be eliminated
(if possible) and any associated hypocalcemia should be
corrected. Phosphate excretion in the urine should be
encouraged with saline and acetazolamide. Gastrointestinal
losses of phosphate can be increased by administering
aluminum hydroxide.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of

hyperphosphatemia?

A

Renal failure
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 356.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three basic mechanisms by which

hyperphosphatemia occurs?

A
  1. Inadequate renal excretion of phosphate, 2. the movement of
    phosphate from inside the cells to outside the cell, and 3.
    increased phosphate or vitamin D intake.
    Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
    Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
    Lippincott Williams and Wilkins; 2013: 356.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly