Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme

Results from a prospective clinical trial

C. L. Clark, G. S. Sacks, Roland Dickerson, K. A. Kudsk, R. O. Brown

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Objective: To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support. Design: Prospective clinical trial. Setting: A 455-bed tertiary care institution, with Level I trauma designation. Patients: Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of <3 mg/dL (<0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity. Interventions: Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (<1.5 mg/dL [<0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days. Measurements and Main Results: Sixty- seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 ± 0.6 to 3.3 ± 0.6 mg/dL (0.84 ± 0.19 to 1.1 ± 0.19 mmol/L) for the mild group; 1.9 ± 0.6 to 2.7 ± 0.6 mg/dL (0.61 ± 0.19 to 0.87 ± 0.19 mmol/L) for the moderate group; 1.3 ± 0.8 to 2.3 ± 0.8 mg/dL (0.42 ± 0.26 to 0.74 ± 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period. Conclusion: The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.

Original languageEnglish (US)
Pages (from-to)1504-1511
Number of pages8
JournalCritical Care Medicine
Volume23
Issue number9
DOIs
StatePublished - Sep 19 1995

Fingerprint

Hypophosphatemia
Phosphorus
Clinical Trials
Therapeutics
Serum
Calcium
Urea
Albumins
Creatinine
Nitrogen
Parathyroid Diseases
Tertiary Healthcare
Magnesium
Renal Insufficiency
Obesity

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme : Results from a prospective clinical trial. / Clark, C. L.; Sacks, G. S.; Dickerson, Roland; Kudsk, K. A.; Brown, R. O.

In: Critical Care Medicine, Vol. 23, No. 9, 19.09.1995, p. 1504-1511.

Research output: Contribution to journalArticle

@article{f71feecca36b4dc0a7a628f16151aea3,
title = "Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: Results from a prospective clinical trial",
abstract = "Objective: To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support. Design: Prospective clinical trial. Setting: A 455-bed tertiary care institution, with Level I trauma designation. Patients: Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of <3 mg/dL (<0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity. Interventions: Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (<1.5 mg/dL [<0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days. Measurements and Main Results: Sixty- seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 ± 0.6 to 3.3 ± 0.6 mg/dL (0.84 ± 0.19 to 1.1 ± 0.19 mmol/L) for the mild group; 1.9 ± 0.6 to 2.7 ± 0.6 mg/dL (0.61 ± 0.19 to 0.87 ± 0.19 mmol/L) for the moderate group; 1.3 ± 0.8 to 2.3 ± 0.8 mg/dL (0.42 ± 0.26 to 0.74 ± 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period. Conclusion: The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.",
author = "Clark, {C. L.} and Sacks, {G. S.} and Roland Dickerson and Kudsk, {K. A.} and Brown, {R. O.}",
year = "1995",
month = "9",
day = "19",
doi = "10.1097/00003246-199509000-00010",
language = "English (US)",
volume = "23",
pages = "1504--1511",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme

T2 - Results from a prospective clinical trial

AU - Clark, C. L.

AU - Sacks, G. S.

AU - Dickerson, Roland

AU - Kudsk, K. A.

AU - Brown, R. O.

PY - 1995/9/19

Y1 - 1995/9/19

N2 - Objective: To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support. Design: Prospective clinical trial. Setting: A 455-bed tertiary care institution, with Level I trauma designation. Patients: Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of <3 mg/dL (<0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity. Interventions: Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (<1.5 mg/dL [<0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days. Measurements and Main Results: Sixty- seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 ± 0.6 to 3.3 ± 0.6 mg/dL (0.84 ± 0.19 to 1.1 ± 0.19 mmol/L) for the mild group; 1.9 ± 0.6 to 2.7 ± 0.6 mg/dL (0.61 ± 0.19 to 0.87 ± 0.19 mmol/L) for the moderate group; 1.3 ± 0.8 to 2.3 ± 0.8 mg/dL (0.42 ± 0.26 to 0.74 ± 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period. Conclusion: The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.

AB - Objective: To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support. Design: Prospective clinical trial. Setting: A 455-bed tertiary care institution, with Level I trauma designation. Patients: Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of <3 mg/dL (<0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity. Interventions: Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (<1.5 mg/dL [<0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days. Measurements and Main Results: Sixty- seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 ± 0.6 to 3.3 ± 0.6 mg/dL (0.84 ± 0.19 to 1.1 ± 0.19 mmol/L) for the mild group; 1.9 ± 0.6 to 2.7 ± 0.6 mg/dL (0.61 ± 0.19 to 0.87 ± 0.19 mmol/L) for the moderate group; 1.3 ± 0.8 to 2.3 ± 0.8 mg/dL (0.42 ± 0.26 to 0.74 ± 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period. Conclusion: The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.

UR - http://www.scopus.com/inward/record.url?scp=0029157325&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029157325&partnerID=8YFLogxK

U2 - 10.1097/00003246-199509000-00010

DO - 10.1097/00003246-199509000-00010

M3 - Article

VL - 23

SP - 1504

EP - 1511

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 9

ER -