Background Hypophosphataemia is relatively prevalent in hospitalised patients. Hypophosphataemia may be asymptomatic or may exhibit symptoms varying in severity from confusion to respiratory depression and coma. Management includes the evaluation of symptoms and administration of oral or intravenous phosphate salts. The latter are available as concentrated potassium and sodium solutions and are considered, therefore, as high-alert medications. Thus, their availability on hospital wards should be restricted. Moreover, inadequate phosphate repletion regimens or, conversely, phosphate over-repletion may worsen the patient’s condition and may, especially in the intravenous route, lead to severe disability. Consequently, appropriate phosphate repletion regimens are necessary to ensure patients’ safety.
Purpose To quantify the appropriateness of hypophosphataemia treatment in hospitalised patients.
Material and methods We performed a retrospective observational study in a secondary care hospital. Serum phosphate concentrations of patients hospitalised from January 2016 to December 2016 were screened. Patients with hypophosphataemia, defined as serum phosphate concentration <2.5 mg/dL, were identified. Demographic and laboratory results were derived from the electronic records of included patients.
Hypophosphataemia treatment was considered appropriate if all the following criteria were met:
Oral administration in patients able to swallow and with no known absorption deficiency.
Dosing adjusted to phosphate serum concentration and glomerular filtration rate (GFR).
Timely monitoring of serum phosphate concentration.
Appropriate diluent volume and rate of administration.
We used descriptive statistics to quantify treatment appropriateness.
Results We identified 55 patients with hypophosphataemia. Appropriateness criteria were met in eight patients (14.5%). The oral route was used in 13 patients (23.6%) and dosing was adjusted to phosphate serum concentration and GFR in 31 patients (56.4%), Timely phosphate monitoring was performed in 17 patients (30.9%), and appropriate diluent volume and rate of administration was found in 27 patients (49.1%).
Conclusion In this study, treatment of hypophosphataemia was found to be appropriate in only 14.5% of patients included, a result derived largely by failure to use the oral route when appropriate and failure to monitor phosphate serum concentrations. The overuse of phosphate salts in the intravenous route and lack of phosphate monitoring jeopardise patients’ safety. Thus, we suggest the routine review of phosphate repletion regimens by a pharmacist.
No conflict of interest
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