Hypophosphataemia ⬇️
Hypophosphataemia for NCHDs in Irish hospitals: Phospho-Sandoz®, IV phosphate rules, refeeding risk, and Galway/CUH-style thresholds.
🧠 Definition
- Typical Irish laboratory reference approx. 0.8–1.3 mmol/L.
- Clinically significant hypophosphataemia often <0.7 mmol/L; severe often <0.32 mmol/L.
- Confirm trend on repeat sampling, especially before refeeding.
🧾 Common causes
- Refeeding syndrome / malnutrition (monitor per HSE nutrition policy)
- DKA treatment, respiratory alkalosis, hyperparathyroidism
- Alcohol, sepsis, diuretics, phosphate binders / antacids
- Vitamin D deficiency (rarer)
🩺 Symptoms
- Mild: often asymptomatic
- Moderate–severe: weakness, haemolysis, rhabdomyolysis risk
- Severe: respiratory muscle weakness, cardiac dysfunction
- Refeeding: phosphate may fall rapidly — proactive monitoring
🔍 Investigations
- Serum phosphate; daily or more often if refeeding at risk
- Calcium, magnesium, potassium, U&Es
- Liaise dietetics for refeeding plans
💊 Management (Irish hospital practice)
- Treat cause; senior doctor review before IV phosphate.
- Oral: Phospho-Sandoz® 1–2 tablets in 100 ml water every 8 h (16 mmol PO₄³⁻ per tablet).
- Oral preferred if >0.32 mmol/L and asymptomatic, or >0.48 mmol/L and symptomatic (common Irish thresholds).
- IV if <0.32 mmol/L, symptomatic with <0.48 mmol/L, or cannot tolerate oral — sodium phosphate ampoules; potassium phosphate only if K⁺ also low.
- Never IV bolus phosphate. Dilute ampoules and infuse over ≥6 h; monitor Ca²⁺, Mg²⁺, K⁺ every 6–12 h.
- Correct hypocalcaemia; avoid Hartmann's as diluent for sodium phosphate (incompatible with Ca/Mg salts).
📈 Replacement tool
- Use the tool below — aligned with common Irish pharmacy guidance (e.g. CUH / UHG). Confirm locally.
Phosphate replacement
Irish hospital guidance — senior review before IV; confirm local protocol
Typical Irish reference approx. 0.8–1.3 mmol/L. Phospho-Sandoz® for oral replacement. IV phosphate must never be given as a bolus. Monitor Ca²⁺, Mg²⁺ and K⁺; caution in refeeding and renal impairment.
Note Template
Ready-to-use clinical note structure
🕒 08 / 10 / 2026 — 16:08 ATRP re: hypophosphataemia Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [malnutrition, alcohol, DKA, refeeding risk] 🧾 Hx: • Refeeding / poor intake / DKA treatment • Weakness, respiratory symptoms • Concurrent electrolyte abnormalities 🩺 Exam: • Vitals and respiratory effort • Nutrition and hydration status 📋 Impression: Likely cause: [refeeding / DKA recovery / malnutrition / other] 📌 Plan: • Serum phosphate, Ca²⁺, Mg²⁺, K⁺ — trend if at risk • Oral or IV phosphate per protocol • Liaise dietetics if refeeding • Monitor calcium during correction 👤 [Your Name], [Role] IMC: _______
Educational reference only. Medical disclaimer