Additional References: Treatment of hypophosphotemia Treatment of Hypophosphatemia (MKSAP Nephro Text)
HYPERPHOSPHOTEMIA: -- 2/2 (CKD, Increased Cell turnover, Cell Injury, Exogenous administration) – Rx.a. Phosphate binder in CKD (esp if Ca x PO43- >55) b. Hemodialysis is Acute Phosphate Nephropathy c. Hemodialysis if tumor lysis syndrome with severe hyperphosphatemia (serum phosphate >10 mg/dL [3.23 mmol/L]) and concomitant oliguria
THE FLUID REPLACEMENT- Key Concepts to Understand
- First:
- Most important thing is to understand the electrolyte composition of normal body fluids, and the replacement fluid.
- If you do not know this, you will not have a true understanding of which fluid to replace in which circumstances.
- Second:
- You must know the normal physiological distribution of body fluid. Also, you should know the expected distribution of replacement fluids.
- Third
- Fluid that you are repleting should resemble normal physiological fluid as much as possible.
- Fourth:
- Fluid you are replacing should not cause drastic change in electrolyte composition.
- Fifth:
- You should reassess the need of fluid every day.
- Normal Maintainance Requirement: BMJ 2015
- Water: 25-30 mL/kg/day
- Sodium, potassium, and chloride: up to 1 mmol/kg/day
- Glucose: 50-100 g/day
- Mechanism of Fluid retention (in CHF, Liver failure, Nephrotic Syndrome)
- Increased sodium retention due to RAAS (more than oncotic pressure theory)
- However, ARB and ACEI does not work very well
- Aldactone ofcourse does
- Furosemide when given causes dilution of medullary gradient thus affecting the free water retention
- Also, diuresis is more effective if patient is in supine position due to decreased RAAS while in supine position
- References:
 N Engl J Med 2013;369:1243-51
Distribution of IV Fluid in Body on Replacement  BMJ 2014;350:g7620
N Engl J Med 2013;369:1243-51
 Lancet 2012; 379: 2466–76
Lancet 2012; 379: 2466–76 |
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N Engl J Med 2013;369:1243-51
BMJ 2014;350:g7620 
Lancet 2012; 379: 2466–76 
