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Geerse et al. Critical Care 2010, 14:R147 http://ccforum.com/content/14/4/R147


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Treatment of hypophosphatemia in the intensive care unit: a review
Daniël A Geerse1*, Alexander J Bindels1, Michael A Kuiper2,3,4, Arnout N Roos1, Peter E Spronk3,4,5, Marcus J Schultz3,4,6

Introduction: Currently no evidence-based guideline exists for the approach tohypophosphatemia in critically ill patients. Methods: We performed a narrative review of the medical literature to identify the incidence, symptoms, and treatment of hypophosphatemia in critically ill patients. Specifically, we searched for answers to the questions whether correction of hypophosphatemia is associated with improved outcome, and whether a certain treatment strategy is superior. Results:Incidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Treatment: hypophosphatemia is generally corrected when it is symptomatic orsevere. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Outcome: in some studies, hypophosphatemia was associated with higher mortality; a paucity of randomized controlled evidence exists for whether correction of hypophosphatemia improves the outcome in critically ill patients.Conclusions: Additional studies addressing the current approach to hypophosphatemia in critically ill patients are required. Studies should focus on the association between hypophosphatemia and morbidity and/or mortality, as well as the effect of correction of this electrolyte disorder.

Introduction Electrolyte disorders frequently develop in critically ill patients during course of stay in theintensive care unit (ICU). Therefore, ICU patients are routinely monitored for electrolyte disorders, and it is common practice to correct them. Hypophosphatemia is one of those frequently encountered electrolyte disorders, for which many causative factors are present in critically ill patients. It is uncertain when and how to correct hypophosphatemia, and whether correction affects outcome incritically ill patients. We searched the literature on hypophosphatemia in ICU patients to identify the incidence, symptoms, and treatment of hypophosphatemia. We searched for answers to
* Correspondence: dgeerse@hotmail.com 1 Department of Intensive Care Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands Full list of author information is available at theend of the article

the following questions: (a) whether correction of hypophosphatemia is associated with improved outcome; and (b) whether a certain treatment strategy is superior.

Materials and methods The Medline database was searched to identify articles from 1969 to 2010 containing the Medical Subjects Heading (MeSH) term “hypophosphatemia.” We included clinical studies and experimentaltrials, as well as case reports. Results were limited to articles in the English language and to articles on humans. This search yielded 1,413 articles. The Cochrane Library was also searched for current trials on hypophosphatemia, which yielded no results. All articles were screened for relevance to critically ill patients; these articles were studied in detail. Notably, articles on chronichypophosphatemia (for example, hereditary hypophosphatemic syndromes) were excluded.

© 2010 Geerse et al.; licensee BioMed Central Ltd This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is...