phosphate replacement therapies

• In adults with symptomatic mild hypophosphatemia (2-2.5 mg/dL [0.65-0.81 mmol/L])
• treat with increased dietary phosphate or oral phosphate supplements 1,000-2,000 mg/day.

In adults with moderate hypophosphatemia (1-2.5 mg/dL [0.32-0.81 mmol/L]):

• If nonventilated, treat with oral phosphate 1,000-2,000 mg/day (32 mmol/day).
• If ventilated, treat with IV phosphate 0.08-0.16 mmol/kg (2.5-5 mg/kg) over 2-6 hours as the initial dose.

In adults with severe hypophosphatemia (< 1 mg/dL [0.32 mmol/L]), treat with IV phosphate, regimens depend on clinical presentation:

• If it is asymptomatic, treat with phosphate 2.5 mg/kg (0.08 mmol/kg) IV over 6 hours.
• If it is symptomatic, treat with phosphate 5 mg/kg (0.16 mmol/kg) IV over 6 hours.
• If more intensive regimen is necessary, treat with phosphate 10 mg/kg (0.32 mmol/kg) IV over 12 hours.

Consider rapid infusion of potassium phosphate (given over 2-3 hours) for critically ill patients.