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Phosphate • Distributed in Similar Concentrations Throughout Intracellular and Extracellular

Phosphate • Distributed in Similar Concentrations Throughout Intracellular and Extracellular

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Published by hollyu

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Published by: hollyu on Nov 19, 2009
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05/15/2010

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Phosphate
distributed in similar concentrations throughout intracellular andextracellular fluid.90% in bone, 10% is intracellular, and <1%, in the ECF.
free ion (55%), complexed ion (33%), and in a protein-bound form (12%).
Control of phos concentration by altered renal excretion and redistributionwithin the body compartments.
Absorption occurs in the duodenum and jejunum and is largely unregulated.Phos reabsorption in the kidney is primarily regulated by PTH, dietaryintake, and insulin-like growth factor.
Phos provide the primary energy bond in ATP and creatine phosphate.Therefore, severe phosphate depletion results in cellular energy depletion.
Phos is an essential element of second-messenger systems, including cAMPand phosphoinositides, and a major component of nucleic acids, phospholipids, and cell membranes.
As part of 2,3-DPG, phos is important for off-loading oxygen from thehemoglobin molecule.
 
Hypophosphatemia
CNS: paresthesias, myopathy, encephalopathy, delirium, seizures, andcoma.
Hematologic: dysfunction of erythrocytes, platelets, and leukocytes.
Muscle weakness and malaise are common.
Respiratory muscle failure and myocardial dysfunction are potential problems of particular concern to anesthesiologists.
Rhabdomyolysis is a complication of severe hypophosphatemia.
Carbohydrate-induced hypophosphatemia (the “refeeding syndrome”), andduring medical management of DKA.
Acute alkalemia, which may reduce serum PO4, Hyperventilation to aPaCO2 of 20 mm Hg may reduce the serum PO4
Excessive renal loss of PO4 with hyperparathyroidism, hypomagnesemia,hypothermia, diuretic therapy, and renal tubular defects in PO4 absorption.
GI loss due to the use of PO4-binding antacids or to malabsorptionsyndromes.
 
Measurement of urinary PO4 aids in differentiation due to renal losses fromthat due to excessive GI losses or redistribution of PO4 into cells
Patients with severe or symptomatic require IV phos administration
15-mmol boluses (465 mg) mixed with 100 ml of 0.9% sodium chlorideand given over a 2-hour period safely repletes phosphate.
Phosphate should be administered cautiously to hypocalcemic patients because of the risk of precipitating more severe hypocalcemia.

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