Clark C L, Sacks G S, Dickerson R N, Kudsk K A, Brown R O
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
Crit Care Med. 1995 Sep;23(9):1504-11. doi: 10.1097/00003246-199509000-00010.
To determine the safety and efficacy of a graduated dosing scheme of phosphorus replacement therapy in patients with hypophosphatemia receiving specialized nutrition support.
Prospective clinical trial.
A 455-bed tertiary care institution, with Level I trauma designation.
Seventy-eight adult patients, followed and co-managed by a multidisciplinary Nutrition Support Service, with a serum phosphorus concentration of < 3 mg/dL (< 0.97 mmol/L) and no evidence of renal insufficiency, calcium or parathyroid disorders, or obesity.
Patients were enrolled into one of three categories based on their serum phosphorus concentration: mild hypophosphatemia (2.3 to 3 mg/dL [0.74 to 0.97 mmol/L]), moderate hypophosphatemia (1.6 to 2.2 mg/dL [0.52 to 0.71 mmol/L]), or severe hypophosphatemia (< 1.5 mg/dL [< 0.48 mmol/L]). Each patient received one intravenous phosphorus bolus dose, based on the assigned category of hypophosphatemia, according to a graduated dosing scheme: 0.16 mM/kg (mild), 0.32 mM/kg (moderate), or 0.64 mM/kg (severe). Serum/blood concentrations of phosphorus, calcium, albumin, magnesium, urea nitrogen, and creatinine were measured for three consecutive days.
Sixty-seven patients completed the protocol. There were 31 patients with mild hypophosphatemia, 22 patients with moderate hypophosphatemia, and 14 patients with severe hypophosphatemia. Serum phosphorus concentrations increased significantly (p < .001) in all groups after the phosphorus bolus: 2.6 +/- 0.6 to 3.3 +/- 0.6 mg/dL (0.84 +/- 0.19 to 1.1 +/- 0.19 mmol/L) for the mild group; 1.9 +/- 0.6 to 2.7 +/- 0.6 mg/dL (0.61 +/- 0.19 to 0.87 +/- 0.19 mmol/L) for the moderate group; 1.3 +/- 0.8 to 2.3 +/- 0.8 mg/dL (0.42 +/- 0.26 to 0.74 +/- 0.26 mmol/L) for the severe group. There were no clinically significant changes in serum/blood calcium, albumin, urea nitrogen, or creatinine concentrations and no adverse reactions to the phosphorus regimens throughout the 3-day study period.
The graduated dosing scheme of phosphorus replacement therapy is both safe and efficacious in patients receiving specialized nutrition support.
确定在接受特殊营养支持的低磷血症患者中，逐步递增剂量的磷替代治疗方案的安全性和有效性。
前瞻性临床试验。
一家拥有455张床位的三级医疗机构，具备一级创伤救治资质。
78名成年患者，由多学科营养支持服务团队进行随访和共同管理，血清磷浓度<3mg/dL（<0.97mmol/L），且无肾功能不全、钙或甲状旁腺疾病或肥胖的证据。
根据患者血清磷浓度将其分为三类：轻度低磷血症（2.3至3mg/dL[0.74至0.97mmol/L]）、中度低磷血症（1.6至2.2mg/dL[0.52至0.71mmol/L]）或重度低磷血症（<1.5mg/dL[<0.48mmol/L]）。根据逐步递增的剂量方案，每位患者根据指定的低磷血症类别接受一次静脉注射磷推注剂量：0.16mmol/kg（轻度）、0.32mmol/kg（中度）或0.64mmol/kg（重度）。连续三天测量血清/血液中的磷、钙、白蛋白、镁、尿素氮和肌酐浓度。
67名患者完成了方案。有31名轻度低磷血症患者、22名中度低磷血症患者和14名重度低磷血症患者。磷推注后所有组的血清磷浓度均显著升高（p<0.001）：轻度组从2.6±0.6mg/dL（0.84±0.19mmol/L）升至3.3±0.6mg/dL（1.1±0.19mmol/L）；中度组从1.9±0.6mg/dL（0.61±0.19mmol/L）升至2.7±0.6mg/dL（0.87±0.19mmol/L）；重度组从1.3±0.8mg/dL（0.42±0.26mmol/L）升至2.3±0.8mg/dL（0.74±0.26mmol/L）。在为期3天的研究期间，血清/血液中的钙、白蛋白、尿素氮或肌酐浓度无临床显著变化，且对磷治疗方案无不良反应。
在接受特殊营养支持的患者中，逐步递增剂量的磷替代治疗方案既安全又有效。
