Hyperphosphatemia

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Hyperphosphatemia

  • Definition: Phosphate >4.5mg/dL (1.45 mmol/L)
  • Causes
    • Decreased Renal Excretion (MC)
      • Acute < Chronic Kidney Disease
      • Hypoparathyroidism
    • Transcellular Shift from ICF to ECF
      • Rhabdomyolysis
      • Tumor Lysis Syndrome
      • Massive Hemolysis
      • Metabolic Acidosis
      • Insulin Deficiency (DKA) > Lactic Acidosis
      • Fulminant Hepatitis
      • Severe Hyperthermia
    • Increased Intake
      • Vitamin D analog use
      • Bisphosphonates
      • Fosphenytoin
      • Phospho-soda Enemas (Fleet)
    • Pseudo
      • Hyperbilirubinemia
      • Hyperlipidemia
      • Hemodialysis
      • Hemolyzed sample
      • Liposomal Amphotericin B
      • Paraproteinemia (multiple myeloma)
    • Increased Reabsorption
      • Tumoral Calcinosis (FGF23 defect)
  • Symptoms
    • Asymptomatic
      • Related to hypocalcemia
      • Binds calcium and precipitates it in the tissue
    • Metastatic calcifications may occur
      • Painful nodules, calcification of soft tissues, pruritis
    • Calciphylaxis
  • Complications
    • Renal Osteodystrophy
    • Phosphate nephropathy
  • W/U: Calcium-Phosphate Product
    • Predicts risk of calciphylaxis (>70 causes a risk of calciphylaxis)
  • Treatment
    • Should correct within 12-24hr if normal kidney function
    • Acute
      • Phosphate restricted diet
      • Stop VitD
      • Increase Renal Excretion
      • Normal Saline (IVF) and Acetazolamide +/- Lasix
      • Hemodialysis
        • Increase frequency or duration
    • Renal Failure
      • Phosphate restricted diet + oral phosphate binders
      • Sevelamer (Renagel)
        • 800mg TID w/meals, double dose PRN
        • Check med interactions (may absorb some drugs)
        • Preferable in dialysis, avoids mg/ca problems
      • Calcium acetate (PhosLo)
        • 667mg (two tablets TID w/meals)
        • Pts with significant hypocalcemia and Ca-phos product <70
        • Avoid in hypercalcemia, product >66, vitD intoxication
      • Lanthanum
      • Calcium carbonate

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