Towards Safer Phosphate Repletion: A 24-Hour Weight-Based Infusion Protocol for Hypophosphatemic ICU Patients
| Author | Washington Lima Júnior | en |
| Author | Debora Cerqueira Calderaro | en |
| Author | Rogerio Passos | en |
| Author | Margaret Côrte | en |
| Author | José Adalberto Leal | en |
| Author | Marcelo Oliveira Mayrink | en |
| Author | Gilda Aparecida Ferreira | en |
| Orcid | Washington Lima Júnior [0000-0002-5259-7377] | en |
| Orcid | Debora Cerqueira Calderaro [0000-0001-5535-3223] | en |
| Orcid | Rogerio Passos [0000-0002-3891-6909] | en |
| Orcid | Margaret Côrte [0000-0002-3891-6909] | en |
| Orcid | José Adalberto Leal [0000-0002-1932-7500] | en |
| Orcid | Marcelo Oliveira Mayrink [0000-0002-6642-9753] | en |
| Orcid | Gilda Aparecida Ferreira [0000-0002-1352-7261] | en |
| Issued Date | 2025-10-31 | en |
| Abstract | Background: Evidence on the safety and efficacy of phosphate (P) replacement in hypophosphatemic intensive care unit (ICU) patients remains limited. Objectives: To evaluate the efficacy and safety of a 24-hour weight-based intravenous phosphate replacement protocol. Methods: Adult ICU patients with hypophosphatemia received potassium acid phosphate (25 mL) diluted in 500 mL of saline or 5% glucose, administered via infusion pump. Dosing was 0.3 mmol/kg/24 h for mild hypophosphatemia (0.65 - 0.73 mmol/L) and 0.6 mmol/kg/24 h for moderate to severe cases (≤ 0.64 mmol/L). Phosphate levels were measured every 24 hours. Efficacy was defined as normalization of phosphate within 24 hours. Safety outcomes included hypocalcemia, hypotension, hyperphosphatemia, hyperkalemia, and acute kidney injury. Results: Among 134 patients (aged 67.6 ± 14.6 years; 55% female; median APACHE II median 18), 197 hypophosphatemia episodes were treated. Phosphate normalized within 24 hours in 121 episodes (61%). Mild adverse events occurred in 28 patients (21%); no severe complications were reported. Conclusions: This protocol is not a replacement for standard guidelines in symptomatic hypophosphatemia and unstable patients. It proved effective and generally safe in critically ill patients with mild to severe hypophosphatemia, offering a feasible approach in resource-limited ICU settings where oral formulations are unavailable and frequent laboratory monitoring is unfeasible. | en |
| DOI | https://doi.org/10.5812/mcj-163990 | en |
| Keyword | Hypophosphatemia | en |
| Keyword | Intensive Care Units | en |
| Keyword | Repletion | en |
| Publisher | Brieflands | en |
| Title | Towards Safer Phosphate Repletion: A 24-Hour Weight-Based Infusion Protocol for Hypophosphatemic ICU Patients | en |
| Type | Brief Report | en |
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