Phosphorus Disorder

Question 1

Normal values of Phosphorus

Answer 1

2.5 - 4.5 mEq/L
-intracellular

-it is the building block for ATP -> functions in
Glycolysis
metabolic reactions
delivery of oxygen to the tissues

Question 2

Causes of Hypophosphatemia

Answer 2

-below 2.4 mg/dL

-chronic alcoholism (also in hypomagnesemia)
-refeeding syndrome
-meds (diuretics, phosphate binders)

Question 3

Signs and symptoms of Hypophosphatemia

Answer 3

when severe:
-Irritability
-weakness
-confusion
-respiratory failure
-decrease in diaphragm contractility -> respiratory failure

Question 4

Refeeding syndrome

Answer 4

-collection of symptoms caused by metabolic and hormonal changes due to rapid feeding of patients who had malnutrition for a long time (enteral or parenteral)

-Signs: profound electrolyte derangements: especially hypophosphatemia (below 1) and hypoglycemia

-monitor electrolytes, glucose, gradual nutrition

Question 5

Treatment of Hypophosphatemia

Answer 5

-Mild-moderate: 1-2.3 mg/dl
K/Phos or Na/Phos (depending on if the patient has other K or Na deficiency)
1-2 packets 2-4x daily as tolerated

-Severe: <1 mg/dl
K/Phos or Na/Phos
15-45 mmol IV over 4-6h

Question 6

Causes of Hyperphosphatemia

Answer 6

-more than 4-5 mg/dl

-AKI, CKD, hyperparathyroidism

Question 7

Signs and Symptoms of Hyperphosphatemia

Answer 7

-usually asymptomatic

-N/V
-lethargy
-seizures
-nephrolithiasis
-calciphylaxis

Question 8

Treatment of Hyperphosphatemia

Answer 8

-Phosphate binders

Calcium-containing:
Calcium carbonate (TUMS, Caltrate)
Calcium Acetate (PhosLo, Eliphos)

Non-calcium-containing:
Sevelamer (Renvela)
Lanthanum (Fosrenol)
Sucroferric oxyhydroxide (Velphoro)
Ferric citrate (Auryxia)

in severe cases: hemodialysis doesn’t fully remove phosphates -> patients will need hemodialysis and oral phosphate binders