Hyperphosphatemia

♥Jaclyn Yap♥Sheena Cogo

HyperPhosphatem

ia

Phosphorus(Phosphate)

Function:• Essential for function of Muscle and RBC• Essential for formation of ATP and 2,3-

diphosphoglycerate(facilitates release of oxygen from hemoglobin)

• Maintenance of acid-base balance as well as Nervous system

• Metaboliism of CHON, CHO, Fats

Risk Factors1. Excessive Intake of phosphorous

Food rich in phosphorous Laxatives and enemas containing phosphate Intravenous phosphate supplementation

Manifestation:Serum level above 4.5 mg/dL in adults

And 6 mg/dL in children

HYPERPHOSPHATEMIARepresents a plasma phosphorus

concentration in excess of 4.5 mg/dL in adults.

VALUESExtracellular – 2.5-4.5 mg/dLIntracellular – 4 meq/kg

Risk Factors2. Rhabdomyolysis3. Chemotherapy

Tumor lysis syndrome

Manifestation (neuromuscular)ParesthesiasTetany

Risk Factors4. Renal Insufficiency

Kidney Failure

5. Hypoparathyroidism deficiency of PTH

Manifestations Hypotension Cardiac Dysrythmias

Risk Factors

6. Vitamin D intoxication

7. DKA (diabetic ketoacidosis)

8. Trauma

Signs & Symptoms

• Neuromuscular manifestation– Paresthesias & Tetany– bone and joint pain due to calcification– muscle weakness– hyperflexia

Signs & Symptoms

• Cardiovascular manifestations• Hypotension

– cardiac Dysrythmias– tachycardia

• GI– anorexia– nausea & vomiting

Nursing Mngt.

• Dietary restriction of foods that are high in phosphate– Hard cheese– Cream– Nuts– Meats– Whole-grain cereals– Dried fruits– Dried vegetables– Sardines– Food made with milk– Poultry

Nursing Mngt.

• Explain to the patient the importance of a balanced diet.

• Monitor daily food intake• Weight daily• Maintain adequate fluid intake(2-3L/day)• Instruct patient to avoid phosphate containing

substance such as laxatives and enemas.

Nursing Mngt

Safety• Keep side rails raised, bed in low postion and open

airway(windows) at bedside• Avoid use of restraints• Monitor serum calcium level• Provide a quiet environment and seizure precaution as

appropriate • Administer phosphate binding agents, helpful in lowering

elevated phosphorous levels associated with hypocalcemia.• Teach the patient to recognize signs of impending hypocalcemia

Medical Mngt.

• Vitamin D preparation such as calcitriol– Oral = Rocaltrol– Parenteral = Calcijex, Paricalcitol (Zemplar)

• Hemodialysis• Phosphate binders• Resin binders– Sevelamer (Renagel)

Medical Mngt.

• Diuretics• Surgery may be indicated for removal of large

calcium phosphorus deposits

Diagnostic Test

• Serum CalciumUseful for diagnosing the primary D/O and

assessing the effects of treatment. Serum calcium < 9 mg/dl

• Serum phosphorusSerum phosphorus levels exceeds 4.5 mg/dL in adults, 5.4 mg/dL in children

• Urine phosphorus– < 0.9 g/24 hours

Nursing Diagnosis

• Knowledge deficit r/t excessive intake of phosphorus and Vit. D

• Decreased cardiac output r/t shifting of fluid from blood to muscles secondary to rhabdomyolysis.

• Imbalanced Nutrition: less than body requirements r/t insufficient intake to meet metabolic demands due episodes of nausea & vomiting, and anorexia.

Nursing Diagnosis

• Activity intolerance r/t muscle weakness secondary to hyporcalcemia

• Risk for injury r/t increased neural excitability secondary to hypocalcemia

END

Reference:•Books:

Ignatavicius (2006), Medical Surgical Nursing 5th Edition, volume 1, pg 243Porth, Carol (2005), Pathophysiology 7th Edition, pg 746, 782-783Smeltzer, Suzzane (2008), Brunner & Suddarths Text Book of Medical Surgical Nursing 11th edition, volume 1, pg 331-333

•Internet:•http://Emedicine.medscape.com/article/767010-overview