Hypophosphatemia

phosphorus
THE NAME ORIGINATES FROM THE GREEK WORDS PHOS MEANING LIGHT AND PHOROS MEANING BEARER.

Significance of Phosphorus
It is a critical constituent of all bodys tissues It is one of the major components of the skeleton,

providing mineral strength to bone. It is essential to the function of muscle and red blood cells, the formation of ATP and 2,3 Diphosphateglycerate and the maintenance of acid-base balance as well as the nervous systemand the intermediary metabolism of carbohydrate, protein, and fat It also functions as a buffer in bone, serum, and urine. The normal serum level is 2.5-4.5 mg/dl (0.8-1.5 mmol/L or maybe as high as 6mg/dl (1.94 mmol/L) in infants.

Phosphorus deficit (hypophosphatemia)

Defintion: Below normal serum concentration of inorganic phosphorus An abnormally low content of phosphorus in lean tissues

Causes:
Deficiency in phosphorus Sever protein-calorie

Contributing factors:

Low magnesium level Low potassium level Hyperthyroidism Respiratory alkalosis

malnutrition Anorexia nervosa Chronic alcoholism Age (elderly debilitated patients unable to eat) Prolonged intense Hyperventilation Alcohol withdrawal Poor dietary intake Diabetic ketoacidosis Major thermal burns Vit. D deficiency

Clinical manifestations:
Neurologic symptoms: Irritability Fatigue Apprehension Weakness Numbness Parethesias Confusion Seizures coma Other symptoms : Muscle damage Muscle weakness Muscle pain Acute rhabdomyolysis Chronic loss Can cause bruising and bleeding from platelet dysfunction

Assessment and diagnostic findings:

Serum phosphorus level less than 2.5mg/dl in adults.

PTH levels are increased in hyperparathyroidism

Serum Mg may decrease due to increased urinary

excretion of Mg Alkaline phosphatase is inceased with osteoblastic activity X-rays may show skeletal changes of Osteomalacia or rickets

Medical management
Goal: prevention of hypophosphatemia

In patients at risk: Closely monitor serum phosphate levels Correction initiated before deficits becomes severe
Adequate amounts of phosphorus should be added to

parenteral solutions.

 In severe cases: Requires prompt attention Aggressive IV phosphorus correction is usually limited to patients whose serum phosphorus levels fall below 1mg/dl and whose GI tract is not functioning. The administration should not exceed to 10mEq/h In less acute situatiuons: Oral phosphorus replacement is usually adequate

Possible dangers of IV phosphorus administration

Tetany

Metastatic calcification

Nursing management:
Identifies patients at risk for hypophosphatemia and monitors

for it. Preventive measures involve gradually introducing the solution For patients with documented hypophosphatemia, careful attention is given to preventing infection In patients requiring correction of phosphorus losses, monitors serum phosphorus levels and document and report early signs of Hypophosphatemia If patients experiences mild hypophosphatemia, food i.e. milk and milk products, organ meats, nuts fish, poultry, and whole grains must be encouraged. Supplements i.e. Neura Phos Capsule or Flees Phospho Soda may be administered as prescribed.