Santiago Maria José, López-Herce Jesús, Urbano Javier, Bellón Jose María, del Castillo Jimena, Carrillo Angel
Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Kidney Int. 2009 Feb;75(3):312-6. doi: 10.1038/ki.2008.570. Epub 2008 Nov 12.
Severe hypophosphatemia can cause generalized muscle weakness, paralysis of the respiratory muscles, myocardial dysfunction, reduced peripheral vascular resistance, and encephalopathy. Here we conducted a prospective study to determine the incidence of hypophosphatemia in 47 children on continuous renal replacement therapy and to evaluate the efficacy and safety of adding phosphate to the replacement and dialysate solutions of 38 pediatric patients. During continuous renal replacement therapy, 68% of patients were found to have hypophosphatemia, significantly more than the 12% of patients at the beginning of therapy. There was no higher incidence of hypophosphatemia among patients requiring insulin, diuretics, parenteral nutrition, or high doses of vasoactive drugs. In the children to whom phosphate was not added to replacement and dialysate solutions, 85% presented with an incidence of hypophosphatemia and 36% required intravenous phosphate replacement, rates significantly higher than in those patients where phosphate was added to the solutions. Phosphate supplementation did not cause any instability of the mixtures or other complications. We show here that the incidence of hypophosphatemia in children on continuous renal replacement therapy is very high. Further, we show that the addition of phosphate to replacement and dialysate solutions is safe and that it reduces the incidence of hypophosphatemia and the need for intravenous phosphate treatment.
严重低磷血症可导致全身肌无力、呼吸肌麻痹、心肌功能障碍、外周血管阻力降低及脑病。我们进行了一项前瞻性研究，以确定47例接受持续肾脏替代治疗的儿童中低磷血症的发生率，并评估在38例儿科患者的置换液和透析液中添加磷酸盐的有效性和安全性。在持续肾脏替代治疗期间，发现68%的患者存在低磷血症，显著高于治疗开始时的12%。在需要胰岛素、利尿剂、肠外营养或高剂量血管活性药物的患者中，低磷血症的发生率并未更高。在置换液和透析液中未添加磷酸盐的儿童中，85%出现低磷血症，36%需要静脉补充磷酸盐，这一比例显著高于在置换液和透析液中添加了磷酸盐的患者。补充磷酸盐未导致任何混合液不稳定或其他并发症。我们在此表明，接受持续肾脏替代治疗的儿童中低磷血症的发生率非常高。此外，我们表明在置换液和透析液中添加磷酸盐是安全的，并且它降低了低磷血症的发生率以及静脉补充磷酸盐治疗的必要性。
