• Anneke Bech, Michiel Blans, Darryl Telting, Hans de Boer, Monique Raaijmakers, and Chantal Mulkens.
• Department of Internal Medicine, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands. Electronic address: annekebech@hotmail.com.
• J Crit Care. 2013 Oct 1;28(5):838-43.

BackgroundHypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available.ObjectiveTo evaluate an individualized phosphate replacement regimen.DesignFifty consecutive intensive care unit patients with a serum phosphate level<0.6 mmol/L were treated with sodium-potassium-phosphate intravenously at a rate of 10 mmol/h. The dose was calculated according to the following equation: Phosphate dose in mmol=0.5×Body Weight×(1.25-[serum Phosphate]). Phosphate levels were measured immediately upon completion of the infusion, as well as the next morning at 8 am.ResultsPost-infusion phosphate levels were >0.6 mmol/L in 98% of the patients. Hyperphosphatemia, hyperkalemia or a decrease in serum calcium were not observed. In about a third of patients serum phosphate decreased to <0.6 mmol/L within the next 24 hours after infusion. The phosphate distribution volume calculated from the results of infusion and corrected for renal phosphate loss during the infusion period was 0.51 L/kg (95% CI 0.42-0.61 L/kg).ConclusionThis study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.Copyright © 2013 Elsevier Inc. All rights reserved.

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