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Always check the serum magnesium level and replete magnesium prior to repleting potassium. Low magnesium can exacerbate renal potassium losses.

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Repletion regimens for hypophosphatemia

Approach

Determine whether IV or PO repletion is indicated. Calculate how many millimoles of elemental phosphorus are indicated. Decide which phosphate salt should be administered. If the serum potassium is < 4.0 mg/dL , administer as potassium phosphate , administer as If the serum potassium is ≥ 4.0 mg/dL , administer as sodium phosphate Round the total dose calculated to the closest preparation dose available (e.g., typically 7.5 mmol for IV, 8 mmol for PO). There are no standard guidelines for phosphate repletion and individual recommendations vary. Consult your pharmacy with any questions, as individual formulations may vary! Do not confuse phosphorous (P) with phosphate (PO 4 3−). The concentration of the substances measured in mmol/L is identical but the mass measured in mg/dL differs by a ratio of around 3:1 (phosphate:phosphorus). [15]

For patients who are critically ill and/or receiving parenteral nutrition [16][17]

Phosphate repletion for critically ill patients and/or receiving TPN Serum phosphorus Recommended regimen Monitoring < 1.6 mg/dL (< 0.51 mmol/L) IV phosphate Monitor serum phosphorus level 6 hours after infusion. after infusion. Consider continuous telemetry 1.6–2.2 mg/dL (0.51–0.71 mmol/L) IV phosphate Monitor serum phosphorus level 6 hours after infusion. 2.2–3.0 mg/dL (0.71–0.96 mmol/L) IV phosphate Monitor serum phosphorus level 6 hours after infusion.

All other patients [13][17]

Phosphate repletion for patients who are not critically ill and not receiving TPN Serum phosphorus Recommended regimen Monitoring < 1.0 mg/dL (< 0.32 mmol/L), symptomatic, and/or unable to take PO IV phosphate Monitor serum phosphorus level 6 hours after infusion. 1.0–1.9 mg/dL (0.32–0.64 mmol/L) If able to take PO: oral phosphate If unable to take PO: IV phosphate Monitor serum phosphorus level 6 hours after infusion (if IV) or at least daily. ≥ 2.0 mg/dL (> 0.64 mmol/L) Repletion generally not indicated Monitor serum phosphorus as needed If the serum potassium is < 4.0 mg/dL, administer phosphate as potassium phosphate. If the serum potassium is ≥ 4.0 mg/dL, administer phosphate as sodium phosphate.

General considerations

> 2–3 mg/dL Goal serum phosphorus level:

Expected increase in serum phosphorus levels: ∼ 0.5 mg/dL with a dose of 0.10 mmol/kg body weight (but this is somewhat unpredictable) with a dose of body weight (but this is somewhat unpredictable) Serum phosphorus levels may not reflect total body stores, as most of the body's phosphorus is stored in the bones and soft tissues. Critically ill patients often have higher phosphorus requirements due to hypermetabolism and high urinary phosphorus excretion. Dosing A standard IV dose is around 15–30 mmol and should not be administered faster than 4.5–7.0 mmol/hour . Reduce the dose by 50% in patients with impaired renal function who are not on hemodialysis. Phosphorus preparations [15] 1 mmol of potassium phosphate contains ∼ 1.5 mEq of potassium 1 mmol of sodium phosphate contains ∼ 1.33 mEq of sodium For IV administration, round the total phosphate dose to the nearest 7.5 mmol for ease of preparation

Acute management checklist for hypophosphatemia

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What are the 3 sacred herbs?

Cedar, sage, sweetgrass, and tobacco are sacred to Indigenous people across North America. These herbs are used to treat many illnesses and are crucial in many ceremonies.

gardens.duke.edu - The Four Sacred Herbs | Duke Gardens

Cedar, sage, sweetgrass, and tobacco are sacred to Indigenous people across North America. These herbs are used to treat many illnesses and are crucial in many ceremonies. Listen to Vickie Jeffries (Occaneechi Band of the Saponi Nation) tell us more about the four sacred herbs. Vickie describes cedar as "the grandfather medicine" and sweetgrass as "the hair of Mother Earth."

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How can you show respect in your relationship with plants?

Indigenous Land Relationships in the Carolinas

An Interactive Audio Tour created by Quinn Smith through the Equity Through Stories Program This tour features 12 short audio recordings of Indigenous people telling their own stories connected to their relationship with the land.

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About Quinn Smith, Jr.

Quinn is a citizen of the Chickasaw Nation, majoring in public policy with a documentary studies certificate. As a documentarian, Quinn strives to challenge our misconceptions of Indigenous people by documenting a long-silenced, shared humanity. What drew Quinn to the Equity through Stories Program was the ability to uplift Indigenous truths and to forge reciprocal relationships with Indigenous people throughout the Carolinas. Quinn does this by interviewing Indigenous people about their relationships with the land and weaving their stories into audio documentaries to be exhibited at the Blomquist Garden of Native Plants. He also initiates seed-sharing and other reciprocal ventures between Indigenous peoples and Blomquist Gardens. Quinn hopes that his work will help to re-educate Duke Garden’s 500,000+ annual visitors and to create a healing space for Indigenous people.

Visit Quinn's website here.

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