Yes

Electrolyte Supplement, Oral

Treatment and prevention of hypophosphatemia or hypokalemia

C

Hyperphosphatemia, hyperkalemia, hypocalcemia, hypomagnesemia, renal failure

Use with caution in patients with renal insufficiency, cardiac disease, metabolic alkalosis; admixture of phosphate and calcium in I.V. fluids can result in calcium phosphate precipitation

>10%: Gastrointestinal: Diarrhea, nausea, stomach pain, flatulence, vomiting

1% to 10%:

Cardiovascular: Bradycardia

Endocrine & metabolic: Hyperkalemia

Neuromuscular & skeletal: Weakness

Respiratory: Dyspnea

<1%: Chest pain, mental confusion, alkalosis, hypocalcemia tetany (with large doses of phosphate), abdominal pain, throat pain, phlebitis, paresthesias, paralysis, acute renal failure

Symptoms of overdose include muscle weakness, paralysis, peaked T waves, flattened P waves, prolongation of QRS complex, ventricular arrhythmias, tetany, calcium-phosphate precipitation

Removal of potassium can be accomplished by various means; removal through the GI tract with Kayexalate® administration; by way of the kidney through diuresis, mineralocorticoid administration or increased sodium intake; by hemodialysis or peritoneal dialysis; or by shifting potassium back into the cells by insulin, glucose infusion, or sodium bicarbonate; calcium chloride reverses cardiac effects.

Decreased effect/levels with aluminum and magnesium-containing antacids or sucralfate which can act as phosphate binders

Increased effect/levels with potassium-sparing diuretics, salt substitutes, or ACE-inhibitors; increased effect of digitalis

Store at room temperature, protect from freezing; use only clear solutions; up to 10-15 mEq of calcium may be added per liter before precipitate may occur

Phosphate salts may precipitate when mixed with calcium salts; solubility is improved in amino acid parenteral nutrition solutions; check with a pharmacist to determine compatibility

I.V. doses should be incorporated into the patient's maintenance I.V. fluids; intermittent I.V. infusion should be reserved for severe depletion situations in patients undergoing continuous EKG monitoring. It is difficult to determine total body phosphorus deficit; the following dosages are empiric guidelines:

0-6 months: 240 mg

6-12 months: 360 mg

1-10 years: 800 mg

>10 years: 1200 mg

Pregnancy lactation: Additional 400 mg/day

Adults: 800 mg

Treatment: It is difficult to provide concrete guidelines for the treatment of severe hypophosphatemia because the extent of total body deficits and response to therapy are difficult to predict. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. It is recommended that repletion of severe hypophosphatemia (<1 mg/dL in adults) be done I.V. because large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable

Pediatric I.V. phosphate repletion:

Children: 0.25-0.5 mmol/kg administer over 4-6 hours and repeat if symptomatic hypophosphatemia persists; to assess the need for further phosphate administration, obtain serum inorganic phosphate after administration of the first dose and base further doses on serum levels and clinical status

Adult I.V. phosphate repletion:

Initial dose: 0.08 mmol/kg if recent uncomplicated hypophosphatemia

Initial dose: 0.16 mmol/kg if prolonged hypophosphatemia with presumed total body deficits; increase dose by 25% to 50% if patient symptomatic with severe hypophosphatemia

Do not exceed 0.24 mmol/kg/day; administer over 6 hours by I.V. infusion

With orders for I.V. phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. Because inorganic phosphate exists as monobasic and dibasic anions, with the mixture of valences dependent on pH, ordering by mEq amounts is unreliable and may lead to large dosing errors. In addition, I.V. phosphate is available in the sodium and potassium salt; therefore, the content of these cations must be considered when ordering phosphate. The most reliable method of ordering I.V. phosphate is by millimoles, then specifying the potassium or sodium salt. For example, an order for 15 mmol of phosphate as potassium phosphate in one liter of normal saline The dosing of phosphate should be 0.2-0.3 mmol/kg with a usual daily requirement of 30-60 mmol/day or 15 mmol of phosphate per liter of TPN or 15 mmol phosphate per 1000 calories of dextrose. Would also provide 22 mEq of potassium.

Maintenance:

I.V. solutions:

Children: 0.5-1.5 mmol/kg/24 hours I.V. or 2-3 mmol/kg/24 hours orally in divided doses

Adults: 15-30 mmol/24 hours I.V. or 50-150 mmol/24 hours orally in divided doses

Oral:

Children <4 years: 1 capsule (250 mg phosphorus/8 mmol) 4 times/day; dilute as instructed

Children >4 years and Adults: 1-2 capsules (250-500 mg phosphorus/8-16 mmol) 4 times/day; dilute as instructed

Avoid administering with oxalate (berries, nuts, chocolate, beans, celery, tomato) or phytate (bran, whole wheat) containing foods

For intermittent infusion, if peripheral line, dilute to a maximum concentration of 0.05 mmol/mL; if central line, dilute to a maximum concentration of 0.12 mmol/mL; maximum rate of infusion: 0.06 mmol/kg/hour; do not infuse with calcium-containing I.V. fluids (ie, TPN)

Serum potassium, calcium, phosphate, sodium, cardiac monitor (when intermittent infusion or high-dose I.V. replacement needed)

ammonia (B)

No information available to require special precautions

No effects or complications reported

Do not swallow the capsule; empty contents of capsule into 75 mL (2.5 oz) of water before taking; take with food to reduce the risk of diarrhea

Capsule must be emptied into 3-4 oz of water before administration

Oral:

Whole cow's milk per mL: Phosphate 0.29 mmol, Na 0.025 mEq, K 0.035 mEq

Neutra-Phos® capsule, powder concentrate: Elemental phosphorus 250 mg, phosphate 8 mmol, Na 7.1 mEq, K 7.1 mEq

Neutra-Phos®-K capsule, powder: Elemental phosphorus 250 mg, phosphate 8 mmol, K 14.2 mEq

K-Phos® Neutral tablets: Elemental phosphorus 250 mg, phosphate 8 mmol, Na 13 mEq, K 1.1 mEq

K-Phos® MF tablets: Elemental phosphorus 125.6 mg, phosphate 4 mmol, Na 2.9 mEq, K 1.1 mEq K-Phos® No. 2: Elemental phosphorus 250 mg, phosphate 8 mmol, Na 5.8 mEq, K 2.3 mEq

K-Phos® Original tablets: Elemental phosphorus 114 mg, phosphate 3.6 mmol, K 3.7 mEq

Uro-KP-Neutral® tablets: Elemental phosphorus 250 mg, phosphate 8 mmol, Na 10.8 mEq, K 1.3 mEq

Intravenous: K phosphate, per mL: Phosphate 3 mmol, K 4.4 mEq