PHRM 825: Fluids and Electrolytes - Electrolytes - PO4- Flashcards
Normal phosphorus blood level
2.5-4.5 mg/dL
Phosphorus is critical for ________ including ______ function
Cellular structure and function; respiratory/cardiac muscle
Phosphorus is important in enzymatic reactions that control ______
Carbohydrate, fat, and protein metabolism
Phosphorus is the source of high-energy bonds in ___
ATP
Phosphorus modulates the _____ of _____as 2,3-disphosphoglycerate
Oxygen carrying capacity of hemoglobin
Phosphorus is regulated by what 4 things?
Intake, vitamin D, parathyroid hormone, and renal function
Phosphorus concentration for mild to moderate hypophosphatemia
1-2 mg/dL
Phosphorus concentration for severe hypophosphatemia
< 1 mg/dL
Causes of hypophosphatemia
- Decreased intake
- Impaired absorption
- Intracellular shifts
Neuro clinical presentation for hypophosphatemia
- Irritability
- Apprehension
- Weakness
- Numbness
- Paresthaesias
- Dysarthria
- Confusion
- Obtundation
- Seizures
- Coma
- Apathy
- Delirium
- Hallucinations
- Paranoia
Clinical presentation for hypophosphatemia in the muscular system
- Myalgia
- Weakness
- Rhabdomyolysis
- Dysphagia
- Ileus
Clinical presentation for hypophosphatemia in the blood
- Hemolysis
- WBC dysfunction
- Platelet dysfunction
Clinical presentation for hypophosphatemia in the skeletal system
- Osteopenia
- Osteomalacia
- Bone pain
Clinical presentation for hypophosphatemia in the cardiac system
- Cardiomyopathy
- Decreased contractility
- Arrhythmia
Clinical presentation for hypophosphatemia in the renal system
ATN
Clinical presentation for hypophosphatemia in the pulmonary system
- Acute respiratory failure
- Slow weaning from vent
- Respiratory muscle fatigue
Treatment for mild to moderate hypophosphatemia
Oral PO4
Oral PO4 meds
- Phos-NaK (10 mMol Phos/packet)
- Fleets Phospho-Soda (4.1 mMol/mL) 5 mL diluted
Treatment for severe hypophosphatemia
IV PO4
IV PO4 meds are available as ____ or ____
Potassium or sodium salts
IV PO4 meds
- KPhos when K+ < 4 mEq/L
- NaPhos when K+ > or = 4 mEq/L
Hypophosphatemia treatment guidelines
- Concentration 2.3-2.9 mg/dL: 0.32 mMol/kg
- Concentration 1.6-2.2 mg/dL: 0.64 mMol/kg
- Concentration <1.6 mg/dL: 1 mMol/kg
1 mMol NaPhos = ____ mEq Na+ and Phos
1.33
1 mMol KPhos = ____ mEq K+ and Phos
1.47
Phosphorus administration
- Give PO as divided doses
- Infuse IV oses no more than 7 mMol/hr
Causes of hyperphosphatemia
- Renal failure/insufficiency
- Hypoparathyroidism
- Excessive exogenous intake
Clinical presentation of hyperphosphatemia
- Soft tissue calcifications
- Concurrent hypocalcemia
When do soft tisue calcifications occur?
When Ca+2 and PO4- product >~60
Treatment of
hyperphosphatemia
- IV calcium
- Decrease phosphate GI absorption
When is treatment of hyperphosphatemia done?
When patients are severely symptomatic
