PHOSPHATE – ELECTROLYTE IMBALANCE (HYPOPHOSPHATEMIA & HYPERPHOSPHATEMIA).pdf

Hypophosphatemia, types, causes, risk factors, pathophysiology, signs and symptoms, diagnostic evaluation, management, nursing management, Hyperphosphatemia, causes, risk factors, pathophysiology, signs and symptoms, diagnostic evaluation, management, nursing management,

1. PHOSPHATE –
ELECTROLYTE IMBALANCE
PREPARED BY DOLISHA WARBI

2. HYPOPHOSPHATEMIA:
Hypophosphatemia is an electrolyte disorder in which there is a low level of phosphate in the blood. Phosphate is
an electrolyte that helps the body with energy production and nerve function. It also helps to build strong bones
and teeth.
85% is found in bones and about 14% is in ICF and only 1% is in ECF.
Phosphate >2.5 mg/dl.
TYPES:
1.Acute hypophosphatemia: It comes on quickly. Acute severe hypophosphatemia with serum phosphate I mg/dl. (<
0.32 mmol/L) is most often caused by transcellular shifts of phosphate often superimposed on chronic phosphate
depletion
2.Chronic hypophosphatemia: It is the result of decreased renal phosphate reabsorption. It develops over time.

3. ETIOLOGY:
§Refeeding of patients after starvation.
§Respiratory alkalosis
§Heat stroke
§Alcoholism
§Severe burns
§Diabetic ketoacidosis
§Kidney disorder, i.e, Fanconi syndrome
§Increased parathyroid hormone levels, as in primary
and secondary hyperparathyroidism.
§Electrolyte disorders, such as hypomagnesemia
and hypokalaemia
§IV/ glucose administration.
§Total parenteral nutrition without phosphorus
§Diuretic therapy
§Aluminium/magnesium based antacids
§Vitamin D deficiency
§Diarrhoea
§Excess use of certain drugs such as - Antacids that
bind to phosphate,
§Theophylline
§bronchodilators, and asthma medicine.
§Hormones such as insulin, glycerine androgens.
§Nutrients such as glucose, fructose and amino acid
§ Mannitol (Osmitrol)
§Bisphosphonates

4. RISK FACTORS:
•Severely malnourished
•Medications such as steroids, diuretics
•Hyperparathyroidism
•Sepsis
•Alcoholic
PATHOPHYSIOLOGY:
Cause depletion of ATP and impaired oxygen delivery to the cells due to deficiency in RBC enzyme which affect every major organ system such as CNS hematologic,
musculoskeletal, respiratory, cardiac vascular and gastrointestinal resulting related sign and symptoms
Insulin helps to stimulate the uptake of phosphate which leads to symptomatic hypophosphatemia (refeeding syndrome)
It may be seen in chronically malnourished patient who are administered carbohydrate, which lead rapid release of insulin.
Hypophosphatemia is caused by the decreased dietary intake or decreased renal absorption

5. SIGNS AND SYMPTOMS:
ØOsteomalacia
ØNeuromuscular disturbances may occurs including progressive encephalopathy, seizures coma, and death.
ØChest muscle weakness can result in respiratory failure.
ØTooth decay or late baby teeth
ØBruising and bleeding from platelet dysfunction
ØLoss of appetite.
ØAnorexia
ØIrritability
ØNumbness
ØConfusion
ØFatigue
ØArrhythmias
ØDysphagia
ØDelirium

6. DIAGNOSTIC EVALUATION:
üMedical history
üBlood test
üPhysical examination
üBlood urea nitrogen (BUN)
üUrinalysis:
üX-rays or bone scans
MANAGEMENT:
•Oral phosphate supplement
•Diet rich in phosphate
•IV infusion of sodium potassium phosphate
•Symptomatic management

7. NURSING MANAGEMENT:
üIdentify and treat underlying causes
üAssess and document changes in the level of consciousness and orientation.
üMonitor cardiovascular, respiratory, neuromuscular, CNS, & haematological status
üDiscontinue medications that contribute
üAdminister phosphorus orally w/vitamin D supplement
üPrepare to administer phosphorus IV when serum levels fall below 1mg/dL and critical clinical manifestations
üAdminister IV phosphorus slowly because of the risks associated
üAssess renal system before administering
üMove client carefully, & monitor for signs of a fracture
üInstruct client to increase intake of phosphorus containing foods while decreasing intake of calcium containing
foods
üCommon Phosphorus Food Sources: Fish, organ meats, nuts, pork, beef, chicken etc.

8. HYPERPOSPHATEMIA:
Hyperphosphatemia is defined as. "A serum phosphate level > 4.5mg/dl. (>1.44 mmol/l) and can be further
characterized as mild (4.5-5.5 mg/dl or 1.44-1.76mmol/L), moderate (5.5-6.5 mg/dl or 1.76-2.08mmol/L) or
severe (6.5mg/dl -2.08 mmol/L).
Too much phosphate in the blood is known as hyperphosphatemia.
It may be due to impair phosphate excretion, excess intake or shift or phosphate from intracellular space into the
extracellular fluid.

9. CAUSES:
1.Increases intake of phosphate
2.Acute or chronic renal failure
3.Tumor lysis syndrome
4.Chemotherapy
5.Others:
§Hypoparathyroidism, hyperthyroidism
or vitamin D intoxication.
§Damage in cells.
§Excess vitamin D.
§Diabetic Ketoacidosis.
§Serve hypothermia.
§Chronic alcoholism
RISK FACTORS:
qObesity
qDiabetes
qHigh calcium levels
qAutoimmune disease
qHigh cholesterol levels
qKidney stones or infections.
qNarrowing of the blood vessels of kidneys

10. PATHOPHYSIOLOGY:

11. CLINICAL MANIFESTATION:
üTetany can result causing tingling sensation in fingertips or around the mouth
üAnemia
üNausea/vomiting
üMuscle weakness
üTachycardia
üItchy skin
üBone and joint pain.
üAltered mental status
üConvulsions and seizures
üNeuromuscular hyperexcitability, i.e, Chvostek and Trousseau signs
üDelirium

12. DIAGNOSTIC EVALUATION:
•Medical history
•Physical examination
•Blood test
•X – rays
•Urine test
MANAGEMENT:
1.Aluminum hydroxide: It can be helpful to biphosphate in patient's blood.
2.Calcium carbonate tablets.
3.Saline diuresis - It can be used to enhance phosphate elimination.
4.Hemodialysis om also lower phosphate levels in case of severe case.

13. NURSING MANAGEMENT:
§Monitor 7 first floors and calcium calcium level.
§Monitor the vital signs of vacation.
§Administer the press pride drops and look for the present of side effects.
§avoid phosphorus od such as hard cheese, cream, nuts, whole grain cereals, dried fruits, dried vegetables and
food made from milk.
§Instruct patient to avoid phosphate containing substances as laxatives and enemas that contain phosphate
§Monitor the I/O
§Encourage patent to perform exercise, and maintain his/her optional functioning
§Advice patient to drink two to three quarts of fluid every 24 hours