A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support

Kaleb A. Brown, Roland Dickerson, Laurie M. Morgan, Kathryn H. Alexander, Gayle Minard, Rex O. Brown

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing algorithm in critically ill trauma patients receiving specialized nutrition support. Methods: Seventy-nine adult trauma patients with hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73-0.96 mmol/L (0.32 mmol/kg, low dose), 0.51-0.72 mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE-II scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate-dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high-dosed group (0.38 ± 0.06 to 0.93 ± 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. Conclusions: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate- and severe-dose regimens effectively increase serum phosphorus concentrations. (Journal of Parenteral and Enteral Nutrition 30:209-214, 2006)

Original languageEnglish (US)
Pages (from-to)209-214
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume30
Issue number3
DOIs
StatePublished - Dec 1 2006

Fingerprint

Phosphorus
nutrition
phosphorus
dosage
Serum
Hypophosphatemia
Potassium
Critical Illness
Wounds and Injuries
potassium
Weights and Measures
Injury Severity Score
APACHE
Parenteral Nutrition
Enteral Nutrition
Magnesium
potassium phosphates
Sodium
sodium phosphate
Calcium

All Science Journal Classification (ASJC) codes

  • Food Science
  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support. / Brown, Kaleb A.; Dickerson, Roland; Morgan, Laurie M.; Alexander, Kathryn H.; Minard, Gayle; Brown, Rex O.

In: Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 3, 01.12.2006, p. 209-214.

Research output: Contribution to journalArticle

Brown, Kaleb A. ; Dickerson, Roland ; Morgan, Laurie M. ; Alexander, Kathryn H. ; Minard, Gayle ; Brown, Rex O. / A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support. In: Journal of Parenteral and Enteral Nutrition. 2006 ; Vol. 30, No. 3. pp. 209-214.
@article{254cb6164b5e480aa7703d1515b28e88,
title = "A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support",
abstract = "Background: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing algorithm in critically ill trauma patients receiving specialized nutrition support. Methods: Seventy-nine adult trauma patients with hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73-0.96 mmol/L (0.32 mmol/kg, low dose), 0.51-0.72 mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE-II scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate-dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high-dosed group (0.38 ± 0.06 to 0.93 ± 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. Conclusions: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate- and severe-dose regimens effectively increase serum phosphorus concentrations. (Journal of Parenteral and Enteral Nutrition 30:209-214, 2006)",
author = "Brown, {Kaleb A.} and Roland Dickerson and Morgan, {Laurie M.} and Alexander, {Kathryn H.} and Gayle Minard and Brown, {Rex O.}",
year = "2006",
month = "12",
day = "1",
doi = "10.1177/0148607106030003209",
language = "English (US)",
volume = "30",
pages = "209--214",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "SAGE Publications Inc.",
number = "3",

}

TY - JOUR

T1 - A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support

AU - Brown, Kaleb A.

AU - Dickerson, Roland

AU - Morgan, Laurie M.

AU - Alexander, Kathryn H.

AU - Minard, Gayle

AU - Brown, Rex O.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Background: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing algorithm in critically ill trauma patients receiving specialized nutrition support. Methods: Seventy-nine adult trauma patients with hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73-0.96 mmol/L (0.32 mmol/kg, low dose), 0.51-0.72 mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE-II scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate-dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high-dosed group (0.38 ± 0.06 to 0.93 ± 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. Conclusions: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate- and severe-dose regimens effectively increase serum phosphorus concentrations. (Journal of Parenteral and Enteral Nutrition 30:209-214, 2006)

AB - Background: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing algorithm in critically ill trauma patients receiving specialized nutrition support. Methods: Seventy-nine adult trauma patients with hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73-0.96 mmol/L (0.32 mmol/kg, low dose), 0.51-0.72 mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE-II scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate-dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high-dosed group (0.38 ± 0.06 to 0.93 ± 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. Conclusions: This weight-based phosphorus-dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderate- and severe-dose regimens effectively increase serum phosphorus concentrations. (Journal of Parenteral and Enteral Nutrition 30:209-214, 2006)

UR - http://www.scopus.com/inward/record.url?scp=33748368894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748368894&partnerID=8YFLogxK

U2 - 10.1177/0148607106030003209

DO - 10.1177/0148607106030003209

M3 - Article

VL - 30

SP - 209

EP - 214

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 3

ER -