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Electrolyte: PHOSPHORUS (Normal: 2.5 – 4.5 mg/dl - adult)LOWCOMPARE & CONTRASTHIGHHYPOPHOSPHATEMIATermsHYPERPHOSPHATEMIAPhosphorus < 2.5 mg/dlDefinitionPhosphorus > 4.5 mg/dlSevere protein Calorie malnutritionAnorexiaAlcoholismOverfeeding with simple carbsElderly debilitated & unable to eatHepatic encelopathyProlonged intense hyperventilation (causes respiratory alkalosis)Alcohol withdrawal Diabetic ketoacidosisMajor thermal burnsCausesRenal failure (most common cause) - ↓ excretion of phosphorusChemotherapy for neoplastic disease↑ phosphorus intakeProfound muscle necrosisHypoparathyroidism Most S/S 2nd to deficiency Impaired cellular energy resources (ATP); impaired oxygen delivery to tissues (2,3 Diph) DPGNeurologicalIrritability, apprehension, weakness, numbness, confusion, seizure, fatigue, paresthesia, comaHyperglycemia2nd to predisposed insulin resistanceMuscle damage2nd to ↓ ATP level in muscle tissue, muscle weakness & pain, acute rhabdomyolysis (disintegration of striated muscle)Impaired ventilation2nd to weakened resp. musclesSigns & SymptomsCardiacRespiratoryNeurologicalGeneralSimilar to S/S of hypocalcemiaTetanyTingling then numbness (fingertips & around mouth); Spreads proximally to limbs & face ↑ severityMuscle spasm & painProgressive renal impairment*If phosphorus ↑, calcium ↓Phos. < 2.5 mg/dlGlucose/insulin admin.PTHAlkaline phosphataseX-rayLab & Diagnostic TestsPhos. > 4.5 mg/dlCalciumX-rayPTHBUN & CreatininePreventionTPN & TF should have adequate PhosphorusPhosphorus – PO → Aluminum Phosphate (Phosphojel)Phosphorus < 1.0 mg/dl (severe)-K-Phosphate or Na-Phosphate -0.2 mMol/kg/hr is max. rate -risk of hypocalcemia & tetanyTreatmentTreat underlying disorderIf 2nd to tumor cell lysis – Allopurinol to prevent urate nephropathyIf 2nd to renal failure-Phosphate binding gels-↓ phosphate diet-DialysisAcute hyperphosphatemiaNS – IVF – promotes renal excretionHypertonic dextrose & regular insulin – drive phos. into cellsHemodialysis or peritoneal dialysis (CAPD)SurgeryIdentify & monitor pt. at riskGradual introduction of TPN & TF (avoid rapid shift of phos.)Prevent infectionMonitor serum phosphate levelsAdminister meds safelyTeach about diet *Most of these patients are malnourishedNursing InterventionsIdentify & monitor pt. at riskMonitor lab resultsPt. education: avoid meds with Phos. (laxatives & enemas)Change in urine outputPt. education: avoid ↑ phos. foods-dried fruit & vegetables-sardines-hard cheeses-whole grain cereal-nuts4957445266065Phosphorus Rich FoodsEggsNutsWhole grainsMeatFish PoultryMilk productsKEY POINTS:Essential for function of muscle & RBCsEssential to nervous systemEssential to metabolism of:CarbohydrateProteinFatsCrucial to cell membrane activity Aids in formation of ATP & 2,3 diphosphoglycerateMaintenance in acid-base balance85% located in bones & teeth14% located in soft tissue1% located in ECFCritical to nerve & muscle function ................
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