Hyperphosphatemia

Video in English, definition, pathogenesis, symptoms, complications, treatment.

Jas hyperphosphatemia we refer to plasma phosphate levels > 2.3 mmol / l in infants, 1.6 mmol / l in older children.

Etiology

It occurs as a result of increased exogenous intake or endogenous translocation (eg tumorolysis), increased intestinal absorption, decreased renal excretion or as pseudohyperphosphataemia (analytical causes).

Clinical manifestations

Elevated inorganic phosphate in plasma leads to hypocalcemia and further to tetany. Increased Ca x P product in plasma induces precipitation of calcium salts in soft tissues, hypocalcemia occurs (inorganic phosphate also inhibits 1α-hydroxylation and thus reduces the production of 1,25-dihydroxyvitamin D3 → reduced absorption in the intestine). Ectopic calcification is a common complication in patients with chronic renal failure receiving vitamin D supplementation when correction for hyperphosphataemia is inadequate.

Therapy

The initial treatment is, as in the case of acute hypercalcemia, a 1/1 saline infusion of 20 ml / kg i.v. as a bolus. Our goal is hyperhydration, where we calculate the physiological daily fluid requirement as twice the norm. We co-administer furosemide 1 mg / kg i.v. and we try to keep diuresis 3-5 ml / kg / hour. We reduce the intake of protein in the diet. In the extreme case, the indication is hemodialysis.

Source

  • HAVRÁNEK, J .: Dysbalance of other ions .
  • MASOPUST, Jaroslav and Richard PRŮŠA. Pathobiochemistry of metabolic pathways. 2nd edition. Charles University, 2004. 208 p.