Sodium phosphate is preferred for intravenous therapy. Each carton contains 5 tubes of 20 tablets. Stop phosphate replacement (IV or PO) when the serum phosphate is > 2.0 mg/dL unless there is an indication for chronic treatment such as urinary phosphate wasting. Suggest dosage for Codeine Phosphate . Electrolyte Replacement Practice Management Guidelines . 1 mmol/kg of elemental phosphorus (minimum of 40 mmol and a maximum of 80 mmol) can be given in 3 to 4 divided doses over a 24-hour period. Phos NaK 250-500 mg 1 tab four times a day with meals and at bedtime. Had a wrist operation yesterday . Examples include t… Because of that, most hypophosphatemic patients will not require phosphate replacement unless their Phosphate level is less than 2. They come in cartons of 100 tablets. E.g replace vitamin D in patients with vitamin D deficiency. Intravenous phosphate is not completely benign. Serum phosphate, potassium, calcium and magnesium levels should be monitored every 12-24 hours during IV phosphate administration. PATIENT For mild deficiency (phosphate 0.5-0.8 mmol/L) oral therapy is safer and should be used wherever possible. phosphate, Ca2+, K+, Mg2+ ECG; MANAGEMENT. Oral administration Dissolve 1 tablet (16.1 mmol) in 16 ml of water giving a 1 mmol/ml solution. Phosphate level <0.3mmol/L and patient has normal renal function: Sodium glycerophosphate 21.6% IV 40mmol given as 2 x 12 hour infusions, i.e. Oral phosphate replacement In moderate hypophosphataemia, phosphate may be replaced by increasing the dietary intake of dairy product and other foods high in phosphate (on the advice of a dietician). Phosphate Sandoz ® contains sodium dihydrogen phosphate anhydrous (anhydrous sodium acid phosphate) 1.936 g, sodium bicarbonate 350 mg, potassium bicarbonate 315 mg, equivalent to phosphorus 500 mg (phosphate 16.1 mmol), sodium 468.8 mg (Na + 20.4 mmol), potassium 123 mg (K + 3.1 mmol); Polyfusor NA ® contains Na + 162 mmol/litre, K + 19 mmol/litre, PO 4 3-100 mmol/litre; non … Avoid doses in excess of 0.24 mmol/kg if possible; Use slower rates of replacement (0.08 to 0.20 mmol/kg) especially if more recent Hypophosphatemia onset; Risk of precipitating calcium, with secondary Hypocalcemia, Acute Renal Failure and Arrhythmias If the serum potassium is < 4.0 mg/dL, administer as potassium phosphate. They also contain: Phos NaK 250-500 mg 1 … Phosphate can be given in doses up to about 1 g orally 3 times a day in tablets containing sodium phosphate or potassium phosphate. Oral Phosphate Replacement Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Standard Phosphorous (PO 4) Replacement Protocol (For All Patient Types and All Units) MEDITECH Standard Protocol IMPORTANT: Pharmacy must receive a copy of all medication orders (new & change orders). Recheck serum phosphorus level 2 hours after infusion complete. Oral replacement is generally adequate for mild and moderate hypophosphataemia >0.3 mmol/L). Hypotension, hyperphosphataemia, hypocalcaemia, hypernatraemia, dehydration and metastatic calcification are possible adverse effects of intravenous phosphate therapy. Our hospital’s reference range for phosphate is 0.85–1.45 mmol/L. Regardless of whether replacement is given repeat serum phosphate, U&E, Mg2+ Ca2+ and Albumin next day. If the patient is requiring concentrated intravenous phosphate replacement whilst on total parental nutrition please refer to Prince of Wales Hospital clinical business rule Phosphate replacement in patients receiving Total Parenteral Nutrition. A serum phosphate level of less than 2.8 mg/dL defines hypophosphatemia. Phosphate - Sandoz effervescent tablets contain elemental phosphorous 500 mg, present as sodium phosphate monobasic. Children up to 4 years of age—Dose must be determined by your doctor. Hypophosphatemia caused by renal phosphate loss occurs frequently after kidney transplantation. • Use SODIUM phosphate for patients with serum potassium > 4.5 mEq/L and serum sodium < 145mEq/L. Please scan to Pharmacy As Soon As Possible. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Moderate Hypophosphataemia (0.3-0.59mmol/L): Phosphate Sandoz® 1-2 tablets orally three times daily (each tablet contains 16mmol phosphate, 3mmol potassium and 20mmol sodium). Treatment aimed at the cause is recommended for all levels of hypophosphatemia. It is potentially dangerous because it can precipitate with calcium and cause hypocalcemia (because the phosphate binds to calcium), renal failure (due to calcium phosphate precipitation in the kidneys), and possibly fatal arrhythmias. Select the form of phosphate, the dose in mmol, However, such treatment is debatable, because … • ** Elemental magnesium (supplied as magnesium oxide) or Milk of Magnesia may be initiated; however, diarrhea may be a limiting factor. Oral replacement with KCl (mainstay) Potassium phosphate (PO/IV) o Appropriate in pxs with combined hypokalemia and hypophosphatemia Potassium bicarbonate or potassium citrate o For pxs with concomitant metabolic acidosis Hypomagnesemic pxs o Refractory to K replacement alone Potassium phosphate (PO/IV) o Appropriate in pxs with combined Phosphates are used as dietary supplements for patients who are unable to get enough phosphorus in their regular diet, usually because of certain illnesses or diseases. In assumption of systemic phosphorus depletion, the presumed deficit commonly is replaced by oral phosphate supplements. Phosphate Sandoz effervescent tablets are large, white, flat, circular tablets with a slightly rough surface. Treatment of the underlying disorder and oral phosphate replacement are usually adequate in asymptomatic patients, even when the serum concentration is very low. Check serum phosphate levels every 6hours when giving IV phosphate. For Adult. 1.3 to 1.4 mmol/kg of elemental phosphorus (up to a maximum of 100 mmol) can be given in three to four divided doses over a 24-hour period. Decide which phosphate salt should be administered. Oral treatment can be provided using Phosphate Novartis® at the usual dose of 500 mg BID (each 500 mg effervescent tablet dissolved in water provides the equivalent of 16 mmol of phosphate, 3 mmol of potassium and 20 mmol of sodium). PHOSPHATE If K less than or equal to 4.0 mEq/L (Normal range 2.5 - 4.7 mg/dl) Serum Phosphorus Replace with Recheck level less than 1.6 mg/dl. Children up to 4 years of age—Dose must be determined by your doctor. Sodium glycerophosphate 21.6% IV 20mmol (20ml) in 500ml glucose 5% over 12 hours. equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], equivalent to elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit flavor], Brands of combined preparations of Sodium Phosphate and Potassium Phosphate. The average patient requires 1000-2000 mg (32-64 mmol) of phosphate per day for 7-10 days to replenish the body stores. RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates. Repeat the dose within 24 hours if an adequate level (>0.64mmol/L) has not been achieved. E.g. Diarrhoea is a common side effect of oral phosphate therapy and may necessitate a reduction in dose. The 20ml solution contains 20mmol phosphate (1mmol/ml) and 40mmol sodium (2mmol/ml). Symptoms occur when the serum phosphate concentration is less than 2 mg/dL (0.64 mmol/L). Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. 1 tab of K-phos = 250 mg phosphorus, 8 mmol phosphate, 1.1 mEq potassium, 13 mEq sodium. P (MW=31). Separate order must be entered into EPIC for oral replacement. RDA: (1 packet qid = 1 gram phosphorus = 32 mmol) Phosphates Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 … Stop IV repletion when the serum phosphate level is > 1.5 mg/dL and when oral therapy is possible. Potassium phosphate may also be used if potassium is low. 1,2 Intravenous (IV) phosphate replacement carries many potential side effects and is therefore given for severe hypophosphataemia (<0.3 mmol/L) only. Follow your doctor's orders or the directions on the label. E.g. only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. Separate order must be entered into Wiz/HEO for oral replacement. Phosphate supplement: Oral: Elemental phosphorus 250 to 500 mg 4 times/day after meals and at bedtime. Because of that, only use IV phosphate when the serum phosphate level is < 1 mg/dL and patient has symptoms of hypophosphatemia. Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)], Phos-NaK: Dibasic potassium phosphate, monobasic potassium phosphate, dibasic sodium phosphate, and monobasic sodium phosphate per packet (100s) [sugar free; equivalent to elemental phosphorus 250 mg (8 mmol), sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit flavor], If both potassium and phosphorus replacement required, subtract the mEq of potassium given as potassium phosphate from the total amount of potassium required. Exclusions: Renal insufficiency (SCr >2 and/or CrCl < 20 mg/dL), Rhabdomyolysis, DKA, Weight < 50 kg *** Consider oral/enteral replacement if GI tract available *** *** Oral/enteral replacement is preferred in asymptomatic patients *** Hypophosphataemia may be asymptomatic, but clinical symptoms usually become apparent when plasma phosphate concentrations fall below 0.3mmol/L. Considering that the normal adult intake of phosphate is about 35 mmol per day, a reasonable typical IV replacement is 20-40mmol per day. It’s very rare to have symptoms of hypophosphatemia with a serum phosphate > 2 mg/dL. How to prescribe: Prescribe on eMeds using the paediatric - oral electrolyte replacement - phosphate protocol. Round the total dose calculated to the closest preparation dose available (e.g., typically 7.5 mmol for IV, 8 mmol for PO). Phosphate is the drug form (salt) of phosphorus. (consider oral). feed adequately (caution in refeeding syndrome) if phosphate 0.65-0.89 give oral phosphate; IV phosphate:-> KH 2 PO 4 – 10mmol of phosphate and 10mmol of K in 10mL-> NaKH 2 PO 4 – 13.4mmol of phosphate, 21.4mmol Na+, 2.6mmol K in 20mL. Results. Give in at least 120 ml of water to reduce risk of diarrhoea. per dose 50 mmol), increased dose to be used in critically ill patients; dose to be infused over 6–12 hours, according to … If the level gets to 1.5 mg/dL, switch to oral treatment if possible. NB. Oral replacement is usually sufficient but consider intravenous replacement if patient has phosphate level 0.3-0.5mmol/L and is symptomatic or nil-by-mouth or unlikely to absorb oral phosphate. Used in patients with vitamin D deficiency adequate in asymptomatic patients, when... ( 1mmol/ml ) and 40mmol sodium ( 2mmol/ml ) 4 times/day after and. Phosphate when the serum concentration is very low levels of hypophosphatemia with a serum level! 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