Sodium phosphate with potassium dihydrogen phosphate parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for infusion containing sodium phosphate and potassium dihydrogen phosphate.
Drugs List
Therapeutic Indications
Uses
Hypophosphataemia
Dosage
Dosage must be adjusted to the condition of the patient, the fluid, electrolyte and acid-base balance.
Adults
Moderate hypophosphataemia (serum inorganic phosphate 0.5mmol/L to 0.7mmol/L)
0.1 to 0.2mmol phosphate/kg of bodyweight (equivalent to 1ml to 2ml Polyfusor Phosphates/kg bodyweight) over 6 to 12 hours.
Severe hypophosphataemia (serum inorganic phosphate below 0.5mmol/L)
0.2 to 0.5mmol phosphate/kg of bodyweight (equivalent to 2ml to 5ml Polyfusor Phosphates/kg bodyweight) over 6 to 12 hours.
A maximum dose of 50mmol per infusion should not be exceeded.
Not more than 15mmol phosphate/hour should be given.
Children
Children aged over 12 years
(See Dosage; Adult)
The following alternative dosing schedule may be suitable:
Children aged 12 to 18 years: 0.4mmol/kg phosphate daily, by slow intravenous infusion adjusted as necessary.
Children aged 2 to 12 years (unlicensed): 0.4mmol/kg phosphate daily, by slow intravenous infusion adjusted as necessary.
Children aged 1 month to 2 years (unlicensed): 0.7mmol/kg phosphate daily, by slow intravenous infusion adjusted as necessary.
Dilute injection with sodium chloride 0.9% or 0.45% or glucose 5% or 10%. Administration rate of phosphate should not exceed 0.05mmol/kg/hour. In emergencies in intensive care faster rates may be used. Seek specialist advice.
Neonates
The following unlicensed dosing schedule may be suitable in neonates:
1mmol/kg phosphate daily, adjusted as necessary.
Contraindications
Hyperkalaemia
Hypernatraemia
Hyperphosphatemia
Hypocalcaemia
Renal impairment
Precautions and Warnings
Children under 13 years
Elderly
Peripheral oedema
Adrenal insufficiency
Breastfeeding
Cardiac disorder
Congestive cardiac failure
Dehydration
Diabetes mellitus
Hypertension
Pre-eclampsia
Pregnancy
Pulmonary oedema
Severe burn
Administer infusion slowly
Precipitate may form when phosphates added to calcium or magnesium solution
Rapid injection may be cardiotoxic
Monitor acid-base balance
Monitor ECG
Monitor fluid balance
Monitor renal function
Monitor serum electrolytes
Pregnancy and Lactation
Pregnancy
Use intravenous sodium phosphate and potassium dihydrogen phosphate with caution during pregnancy.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
Use intravenous sodium phosphate and potassium dihydrogen phosphate with caution during breastfeeding.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Side Effects
Acute renal failure
Cardiac arrest
Cardiac arrhythmias
Coma
Confusion
Convulsions
Decreased lacrimation
Dehydration
Dizziness
Extraskeletal calcification
Fever
Headache
Heart block
Hyperkalaemia
Hypernatraemia
Hyperphosphataemia
Hypertension
Hypocalcaemia
Hyposalivation
Hypotension
Irritability
Listlessness
Local pain (injection site)
Muscle weakness
Neuro-excitability
Organ damage
Paraesthesia in extremities
Paralysis
Phlebitis (injection site)
Respiratory failure
Restlessness
Somnolence
Tachycardia
Tetany
Thirst
Weakness
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: November 2013
Reference Sources
Summary of Product Characteristics: Phosphates as Polyfusor NA and Freeflex. Fresenius Kabi Ltd. Revised August 2006.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 7 September 2017
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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