CLINICAL USE

Hypophosphataemia

DOSE IN NORMAL RENAL FUNCTION

Oral: According to response; maximum oral dose =100 mmol in 24 hoursIV: 9–30 mmol/day (maximum 500 micromols/kg in critically ill patients); see ‘Other Information’

PHARMACOKINETICS

  • Molecular weight                           :94–97 (Phosphate)
  • %Protein binding                           :No data
  • %Excreted unchanged in urine     : High
  • Volume of distribution (L/kg)       :No data
  • half-life – normal/ESRD (hrs)      :No data

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Dialysed. Dose as in normal renal function
  • HD                     :Dialysed. Dose as in normal renal function
  • HDF/high flux   :Dialysed. Dose as in normal renal function
  • CAV/VVHD      :Dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsAvoid insoluble incompatibilities, e.g. calcium salts

    ADMINISTRATION

    Reconstition

    –

    Route

    IV, oral

    Rate of Administration

    Usually over 6–12 hours

    Comments

    Phosphate polyfusor: give undiluted over 24 hours, peripherallyAddiphos: peripherally – give each vial (20 mL) diluted to 250–500 mL with glucose 5% over 6–12 hours, minimum volume 100 mL (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006); centrally – 20 mL vial made up to 60 mL with glucose 5% over 6–8 hours via syringe driver

    OTHER INFORMATION

    Oral dosing: Phosphate Sandoz – 16.1 mmol phosphate, 20.4 mmol sodium, 3.1 mmol potassium per tabletIV dosing: (i) Phosphate Polyfusor (500 mL) containing: 50 mmol phosphate, 81 mmol sodium, 9.5 mmol potassium. (ii) Addiphos (20 mL) containing: 40 mmol phosphate, 30 mmol sodium, 30 mmol potassium

  • HD                     : patients usually need 15–20 mmol/ day in TPNCAV/VVHD patients usually need 30– 40 mmol/dayDuring IV phosphate replacement, serum calcium, potassium and phosphate should be monitored 6–12 hourly. Repeat the dose within 24 hours if an adequate level has not been achieved. Urinary output should also be monitoredThere is experience giving 15 mmol over 2 hours up to 3 times a dayExcessive doses of phosphate may cause hypocalcaemia and metastatic calcification
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