**4.3 Hyperphosphatemia**

	- 1.Tissue necrosis: Tumor lysis syndrome, rhabdomyolysis, hemolysis, fulminant hepatitis, severe hyperthermia
	- 2.Endocrinopathy: Hypoparathyroidism, hypothyroidism/ hyperthyroidism, adrenal insufficiency, acromegaly
	- 3.Medications: Exogenous phosphate intake (phosphate containing laxatives/enemas, TPN), Vit D toxicity, bisphosphonates, fosphenytoin

• If patient has persistent renal failure, can start oral phosphate binder. Calcium acetate can be useful in patients with concomitant hypocalcemia and should be avoided in patients with hypercalcemia, Vitamin D toxicity and Ca-Phos product>66. Sevelamer is a nonabsorbable resin that is preferred for patients

• Hypophosphatemia is defined as serum phosphate <2.5 mg/dl.

mild (or even moderate) hypophosphatemia are asymptomatic.

respiratory alkalosis, hungry bone syndrome

• Causes of hypophosphatemia are [45]:

• Patients with hypophosphatemia can present with paresthesia, tremors,

seizures, impaired heart contractility, arrythmias, muscle weakness (including the diaphragm). Usually, symptoms occur at levels <1-2.5 mg/dl. Most cases of

1.Shifting phosphate into cells: Diabetic ketoacidosis, refeeding syndrome,

on dialysis [44].

*Treatment of hyperphosphatemia.*

*Electrolytes in the ICU*

*DOI: http://dx.doi.org/10.5772/intechopen.96957*

**Figure 9.**

**155**

**4.4 Hypophosphatemia**


*Calcium Phosphate Product* ¼ *Serum Calcium x Serum Phosphate* (4)

• Acute treatment of hyperphosphatemia (see **Figure 9**) includes treating inciting event, phosphate restricted diet, fluid resuscitation and forced diuresis (acetazolamide+ � furosemide) or dialysis [44].

*Electrolytes in the ICU DOI: http://dx.doi.org/10.5772/intechopen.96957*

#### **Figure 9.**

*Treatment of hyperphosphatemia.*

• If patient has persistent renal failure, can start oral phosphate binder. Calcium acetate can be useful in patients with concomitant hypocalcemia and should be avoided in patients with hypercalcemia, Vitamin D toxicity and Ca-Phos product>66. Sevelamer is a nonabsorbable resin that is preferred for patients on dialysis [44].
