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Hyperphosphatemia

This document discusses hyperphosphatemia, which is defined as a plasma phosphorus concentration over 4.5 mg/dL in adults. Phosphorus is essential for muscle and red blood cell function, ATP formation, and acid-base balance. Risk factors for hyperphosphatemia include excessive phosphorus intake, renal insufficiency, hypoparathyroidism, and diabetic ketoacidosis. Signs and symptoms include neuromuscular issues, cardiovascular problems, and gastrointestinal issues. Treatment involves dietary phosphorus restriction, phosphate binders, dialysis, and increasing vitamin D and parathyroid hormone levels. Nursing care focuses on education, diet, fluid management, safety, and treating related symptoms and conditions.

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499 views18 pages

Hyperphosphatemia

This document discusses hyperphosphatemia, which is defined as a plasma phosphorus concentration over 4.5 mg/dL in adults. Phosphorus is essential for muscle and red blood cell function, ATP formation, and acid-base balance. Risk factors for hyperphosphatemia include excessive phosphorus intake, renal insufficiency, hypoparathyroidism, and diabetic ketoacidosis. Signs and symptoms include neuromuscular issues, cardiovascular problems, and gastrointestinal issues. Treatment involves dietary phosphorus restriction, phosphate binders, dialysis, and increasing vitamin D and parathyroid hormone levels. Nursing care focuses on education, diet, fluid management, safety, and treating related symptoms and conditions.

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S.R.Cogo
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© Attribution Non-Commercial (BY-NC)
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Hyper

Phosphatemia
♥Jaclyn Yap
♥Sheena Cogo
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 Factors
1. 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
HYPERPHOSPHATEMIA
Represents a plasma phosphorus
concentration in excess of 4.5 mg/dL in
adults.

VALUES
Extracellular – 2.5-4.5 mg/dL
Intracellular – 4 meq/kg
Risk Factors
2. Rhabdomyolysis
3. Chemotherapy
Tumor lysis syndrome

Manifestation (neuromuscular)
Paresthesias
Tetany
Risk Factors
4. 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 Calcium
Useful for diagnosing the primary D/O and
assessing the effects of treatment. Serum calcium < 9
mg/dl
• Serum phosphorus
Serum 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
Reference:
•Books:
Ignatavicius (2006),
Medical Surgical
Nursing 5th Edition,
volume 1, pg 243
Porth, Carol (2005),
Pathophysiology 7th
Edition, pg 746, 782-
783
Smeltzer, Suzzane
(2008), Brunner & END
Suddarths Text Book
of Medical Surgical
Nursing 11th edition,
volume 1, pg 331-333
•Internet:
•http://Emedicine.medsca
pe.com/article/767010-
overview

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