Orders Standard Phosphorus Replacement Target PO 4 Level: Greater than or equal to 2.5 mg/dL Management of Phosphate administration Description Oral preparation: Phosphate Phebra effervescent tablet: 16.1 mmol per tablet Prescription For oral supplementation, charted on prescription chart stating dose in mmol, frequency, and mmol/kg/day. PATIENT equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], equivalent to elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit flavor], Brands of combined preparations of Sodium Phosphate and Potassium Phosphate. If the serum potassium is ≥ 4.0 mg/dL, administer as sodium phosphate. Premium Questions. When a treatable cause of the hypophosphatemia is known, then treatment of that underlying cause is of paramount importance and is often curative. The dose medicines in this class will be different for different patients. Critical Care . Hypotension, hyperphosphataemia, hypocalcaemia, hypernatraemia, dehydration and metastatic calcification are possible adverse effects of intravenous phosphate therapy. The 20ml solution contains 20mmol phosphate (1mmol/ml) and 40mmol sodium (2mmol/ml). Recheck serum phosphorus level 2 hours after infusion complete. Phosphorus: (hypophosphatemia) : -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). It is recommended that severe hypophosphataemia be treated intravenously as large doses of oral phosphate may cause diarrhoea; intestinal absorption may be unreliable and dose adjustment may be necessary. Examples include t… Hypophosphatemia caused by renal phosphate loss occurs frequently after kidney transplantation. Give in at least 120 ml of water to reduce risk of diarrhoea. 250mg = 8.06 mmol. If the serum potassium is < 4.0 mg/dL, administer as potassium phosphate. A serum phosphate level of less than 2.8 mg/dL defines hypophosphatemia. Oral phosphate Phosphate-Sandoz Each effervescent tablets contains: PO4 2 … Check serum phosphate levels every 6hours when giving IV phosphate. Phos NaK 250-500 mg 1 … Had a wrist operation yesterday . Introduction. Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 times/day after meals and at bedtime. If the level gets to 1.5 mg/dL, switch to oral treatment if possible. Phosphate level <0.3mmol/L and patient has impaired renal function: Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. per dose 50 mmol), increased dose to be used in critically ill patients; dose to be infused over 6–12 hours, according to … Oral replacement is generally adequate for mild and moderate hypophosphataemia >0.3 mmol/L). Oral treatment can be provided using Phosphate Novartis® at the usual dose of 500 mg BID (each 500 mg effervescent tablet dissolved in water provides the equivalent of 16 mmol of phosphate, 3 mmol of potassium and 20 mmol of sodium). Moderate to severe deficiency requires parenteral replacement for the first dose. Repeat the dose within 24 hours if an adequate level (>0.64mmol/L) has not been achieved. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Phosphate Sandoz ® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). It’s very rare to have symptoms of hypophosphatemia with a serum phosphate > 2 mg/dL. They come in cartons of 100 tablets. For Adult. However, such treatment is debatable, because … RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 … 1 tab of K-phos = 250 mg phosphorus, 8 mmol phosphate, 1.1 mEq potassium, 13 mEq sodium. The average patient requires 1000-2000 mg (32-64 mmol) of phosphate per day for 7-10 days to replenish the body stores. Symptoms occur when the serum phosphate concentration is less than 2 mg/dL (0.64 mmol/L). Our hospital’s reference range for phosphate is 0.85–1.45 mmol/L. Brands of combined preparations of Sodium Phosphate and Potassium Phosphate used for oral phosphate replacement. Children up to 4 years of age—Dose must be determined by your doctor. The dose should be reviewed daily according to phosphate levels. Suggest dosage for Codeine Phosphate . Phosphate - Sandoz effervescent tablets contain elemental phosphorous 500 mg, present as sodium phosphate monobasic. Treatment aimed at the cause is recommended for all levels of hypophosphatemia. Oral/Enteral Electrolyte Replacement . Each carton contains 5 tubes of 20 tablets. Possible symptoms include: weakness, anorexia, malaise, tremor, paraesthesia, seizures, acute respiratory failure, arrhythmias, altered mental status and hypotension. For oral dosage forms (powder for oral solution): To replace phosphorus lost by the body: Adults, teenagers, and children over 4 years of age—The equivalent of 250 mg of phosphorus dissolved in two and one-half ounces of water four times a day, after meals and at bedtime. RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates. o Potassium Phosphate: 15 mmol/250 mL and 21 mmol/250 mL o Sodium Phosphate: 15 mmol/250 mL, 21 mmol/250 mL, and 30 mmol/250 mL Current Serum Phosphorus Level Total Phosphorus Replacement Monitoring 2 – 2.5 mg/dL 15 mmol Potassium Phosphate IV over 4 HR No additional action 1 – 1.9 mg/dL 21 mmol Potassium Phosphate IV over 4 HR If dietary modifications are unsuitable, phosphate supplementation may be given Avoid doses in excess of 0.24 mmol/kg if possible; Use slower rates of replacement (0.08 to 0.20 mmol/kg) especially if more recent Hypophosphatemia onset; Risk of precipitating calcium, with secondary Hypocalcemia, Acute Renal Failure and Arrhythmias For mild deficiency (phosphate 0.5-0.8 mmol/L) oral therapy is safer and should be used wherever possible. Because of that, most hypophosphatemic patients will not require phosphate replacement unless their Phosphate level is less than 2. Oral replacement with KCl (mainstay) Potassium phosphate (PO/IV) o Appropriate in pxs with combined hypokalemia and hypophosphatemia Potassium bicarbonate or potassium citrate o For pxs with concomitant metabolic acidosis Hypomagnesemic pxs o Refractory to K replacement alone Potassium phosphate (PO/IV) o Appropriate in pxs with combined Moderate Hypophosphataemia (0.3-0.59mmol/L): Phosphate Sandoz® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). Some phosphates are used to make the urine … K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], Phos-NaK: Dibasic potassium phosphate, monobasic potassium phosphate, dibasic sodium phosphate, and monobasic sodium phosphate per packet (100s) [sugar free; equivalent to elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit flavor], If both potassium and phosphorus replacement required, subtract the mEq of potassium given as potassium phosphate from the total amount of potassium required. only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. Treatment of the underlying disorder and oral phosphate replacement are usually adequate in asymptomatic patients, even when the serum concentration is very low. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Sodium phosphate is preferred for intravenous therapy. Patients who may require brain stem death testing should have their phosphate maintained above 0.5 mmol/l using Polyfusor Stop phosphate replacement (IV or PO) when the serum phosphate is > 2.0 mg/dL unless there is an indication for chronic treatment such as urinary phosphate wasting. Ingredients. It is potentially dangerous because it can precipitate with calcium and cause hypocalcemia (because the phosphate binds to calcium), renal failure (due to calcium phosphate precipitation in the kidneys), and possibly fatal arrhythmias. Phosphate is the drug form (salt) of phosphorus. For patients who are symptomatic and have a serum phosphate level less than 1.0 mg/dL, IV replacement is recommended, followed by oral replacement once serum phosphate levels reach greater than 1.5 mg/dL. Intravenous phosphate is not completely benign. Phosphate Sandoz effervescent tablets are large, white, flat, circular tablets with a slightly rough surface. If your dose is different, do not change it unless your doctor tells you to do so.The amount of medicine that you take depends on the strength of the medicine. Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. Results. Serum phosphate (reference range 0.7-1.4mmol/L). However, only treat when it’s actually less than 2.0 mg/dL. PHOSPHATE If K less than or equal to 4.0 mEq/L (Normal range 2.5 - 4.7 mg/dl) Serum Phosphorus Replace with Recheck level less than 1.6 mg/dl. 1,2 Inappropriate IV phosphate replacement was … 9 mmol every 12 hours, increased if necessary up to 0.5 mmol/kg (max. phosphate, Ca2+, K+, Mg2+ ECG; MANAGEMENT. They also contain: Established hypophosphataemia (with monobasic potassium phosphate) By intravenous infusion. NB. High doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. Round the total dose calculated to the closest preparation dose available (e.g., typically 7.5 mmol for IV, 8 mmol for PO). Serum phosphate, potassium, calcium and magnesium levels should be monitored every 12-24 hours during IV phosphate administration. For oral dosage forms (powder for oral solution): To replace phosphorus lost by the body: Adults, teenagers, and children over 4 years of age—The equivalent of 250 mg of phosphorus dissolved in two and one-half ounces of water four times a day, after meals and at bedtime. Phosphate replacement can be given either orally, intravenously, intradialytically, or in total parenteral nutrition solutions. Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. 2. Sodium phosphate is preferred for intravenous therapy. E.g. If the patient is requiring concentrated intravenous phosphate replacement whilst on total parental nutrition please refer to Prince of Wales Hospital clinical business rule Phosphate replacement in patients receiving Total Parenteral Nutrition. Potassium Phosphate 15 or 30 mmol IV over 4-6hrs can also be used to replace phosphorus IV if potassium is also low as well. It’s diluted in 250 ml of Normal saline. Decide which phosphate salt should be administered. Regardless of whether replacement is given repeat serum phosphate, U&E, Mg2+ Ca2+ and Albumin next day. Standard Phosphorous (PO 4) Replacement Protocol (For All Patient Types and All Units) MEDITECH Standard Protocol IMPORTANT: Pharmacy must receive a copy of all medication orders (new & change orders). (Conversion: 3 mmols KPO4 = 4.4 mEq K+), From: http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf, The Washington Manual of Medical Therapeutics, Designed by Elegant Themes | Powered by WordPress. • ** Elemental magnesium (supplied as magnesium oxide) or Milk of Magnesia may be initiated; however, diarrhea may be a limiting factor. E.g replace vitamin D in patients with vitamin D deficiency. It is recommended that oral phosphate replacement be used in patients who are symptomatic and have phosphate levels between 1.0-1.9 mg/dL. 1 mmol/kg of elemental phosphorus (minimum of 40 mmol and a maximum of 80 mmol) can be given in 3 to 4 divided doses over a 24-hour period. K-Phos 1-2 tabs PO QID. 1,2 Intravenous (IV) phosphate replacement carries many potential side effects and is therefore given for severe hypophosphataemia (<0.3 mmol/L) only. The following information includes only the average doses of these medicines. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Notify MD 30 mmol KPO4 IV* 6 hours after replacement 1.6 - 1.9 mg/dl 30 mmol KPO4 IV*, or Na/K phos** - 1 package by mouth every 6 hours x … Select the form of phosphate, the dose in mmol, (consider oral). Phosphate level <0.3mmol/L and patient has normal renal function: Sodium glycerophosphate 21.6% IV 40mmol given as 2 x 12 hour infusions, i.e. Stop IV repletion when the serum phosphate level is > 1.5 mg/dL and when oral therapy is possible. Electrolyte Replacement Practice Management Guidelines . Separate order must be entered into Wiz/HEO for oral replacement. Serum Phosphate <1.0 mg/dl; Switch to oral replacement when Serum Phosphate >1.5 mg/dl; Precautions. Oral Phosphate Replacement Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. • Use SODIUM phosphate for patients with serum potassium > 4.5 mEq/L and serum sodium < 145mEq/L. Phosphate distribution varies among patients, so no formulas reliably determine the magnitude of the phosphate deficit. • Phosphate replacement must be ordered in mmol of phosphorus. Phosphates are used as dietary supplements for patients who are unable to get enough phosphorus in their regular diet, usually because of certain illnesses or diseases. Follow your doctor's orders or the directions on the label. Diarrhoea is a common side effect of oral phosphate therapy and may necessitate a reduction in dose. Administration: Phosphate Sandoz Effervescent Tablets: Dissolve one tablet in 16mL of water to give a 1mmol/mL suspension, use the required amount and dispose of any remaining solution. Exclusions: Renal insufficiency (SCr >2 and/or CrCl < 20 mg/dL), Rhabdomyolysis, DKA, Weight < 50 kg *** Consider oral/enteral replacement if GI tract available *** *** Oral/enteral replacement is preferred in asymptomatic patients *** 1.3 to 1.4 mmol/kg of elemental phosphorus (up to a maximum of 100 mmol) can be given in three to four divided doses over a 24-hour period. Oral phosphate replacement In moderate hypophosphataemia, phosphate may be replaced by increasing the dietary intake of dairy product and other foods high in phosphate (on the advice of a dietician). Children up to 4 years of age—Dose must be determined by your doctor. How to prescribe: Prescribe on eMeds using the paediatric - oral electrolyte replacement - phosphate protocol. P (MW=31). A total of 136 patients were included, with 68 patients in both the restricted phosphate group and unrestricted phosphate groups. feed adequately (caution in refeeding syndrome) if phosphate 0.65-0.89 give oral phosphate; IV phosphate:-> KH 2 PO 4 – 10mmol of phosphate and 10mmol of K in 10mL-> NaKH 2 PO 4 – 13.4mmol of phosphate, 21.4mmol Na+, 2.6mmol K in 20mL. Separate order must be entered into EPIC for oral replacement. Because of that, only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. Phosphate Sandoz ® contains sodium dihydrogen phosphate anhydrous (anhydrous sodium acid phosphate) 1.936 g, sodium bicarbonate 350 mg, potassium bicarbonate 315 mg, equivalent to phosphorus 500 mg (phosphate 16.1 mmol), sodium 468.8 mg (Na + 20.4 mmol), potassium 123 mg (K + 3.1 mmol); Polyfusor NA ® contains Na + 162 mmol/litre, K + 19 mmol/litre, PO 4 3-100 mmol/litre; non … Oral phosphate replacement . Medical care for hypophosphatemia is highly dependent on three factors: cause, severity, and duration. Oral Administration: • Applies to patients with magnesium level > 1.5 mg/dL who are asymptomatic and able to tolerate PO or PT meds. Potassium phosphate may also be used if potassium is low. In assumption of systemic phosphorus depletion, the presumed deficit commonly is replaced by oral phosphate supplements. Phosphate Summary: Phosphorus: (hypophosphatemia): -Oral: ~2 packets (16 mmol) Neutra-Phos qid (with meals and at bedtime). Phosphate 0.6-0.8 mmol/l – repeat serum levels at next routine test (2-3 days) unless symptomatic.. Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. To provide guidance on intravenous phosphate replacement for hypophosphatemia. Please scan to Pharmacy As Soon As Possible. Phosphate can be given in doses up to about 1 g orally 3 times a day in tablets containing sodium phosphate or potassium phosphate. E.g. Considering that the normal adult intake of phosphate is about 35 mmol per day, a reasonable typical IV replacement is 20-40mmol per day. MD. 20mmol (20ml) in 500ml glucose 5% over 12 hours x 2. Oral administration Dissolve 1 tablet (16.1 mmol) in 16 ml of water giving a 1 mmol/ml solution. Phos NaK 250-500 mg 1 tab four times a day with meals and at bedtime. 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