Intravenous phosphate in the intensive care unit: More aggressive repletion regimens for moderate and severe hypophosphatemia

Abstract

Objective

To evaluate efficacy and safety of aggressive correction of hypophosphatemia with intravenous potassium phosphate in the ICU.

Design and setting

Randomized interventional prospective study in the medical and surgical ICU of a tertiary university hospital.

Patients

Critically ill patients with hypophosphatemia between June and November 1998.

Measurements and results

Patients with moderate hypophosphatemia (<0.65 and >0.40 mmol/l; n=37) were randomized into two groups: group 1 received 30 mmol potassium phosphate intravenously in 50 ml saline over 2 h, and group 2 received 30 mmol potassium phosphate in 100 ml saline over 4 h. Patients with severe hypophosphatemia (<0.40 mmol/l; n=10) were also randomized into two groups: group 3 received 45 mmol potassium phosphate intravenously in 100 ml saline over 3 h, and group 4 received 45 mmol potassium phosphate in 100 ml saline over 6 h. Electrolytes, blood gas, renal function were monitored until day 3; urine was collected during and until 6 h after infusions. The overall efficacy of the protocols was 98% by the end of the infusion. There was no statistical difference in phosphate values between groups at the end of infusion or at 24 h. No adverse events were noted; one patient had an increase in serum potassium to 6.1 mmol/l. Phosphaturia in all groups was elevated as evidenced by fractional excretion above 20%.

Conclusions

More rapid administration of large potassium phosphate boluses is effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function if baseline serum potassium is below 4 mmol/l.