Hyperphosphatemia
Transcript of Hyperphosphatemia
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♥Jaclyn Yap♥Sheena Cogo
HyperPhosphatem
ia
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Phosphorus(Phosphate)
Function:• Essential for function of Muscle and RBC• Essential for formation of ATP and 2,3-
diphosphoglycerate(facilitates release of oxygen from hemoglobin)
• Maintenance of acid-base balance as well as Nervous system
• Metaboliism of CHON, CHO, Fats
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Risk Factors1. Excessive Intake of phosphorous
Food rich in phosphorous Laxatives and enemas containing phosphate Intravenous phosphate supplementation
Manifestation:Serum level above 4.5 mg/dL in adults
And 6 mg/dL in children
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HYPERPHOSPHATEMIARepresents a plasma phosphorus
concentration in excess of 4.5 mg/dL in adults.
VALUESExtracellular – 2.5-4.5 mg/dLIntracellular – 4 meq/kg
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Risk Factors2. Rhabdomyolysis3. Chemotherapy
Tumor lysis syndrome
Manifestation (neuromuscular)ParesthesiasTetany
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Risk Factors4. Renal Insufficiency
Kidney Failure
5. Hypoparathyroidism deficiency of PTH
Manifestations Hypotension Cardiac Dysrythmias
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Risk Factors
6. Vitamin D intoxication
7. DKA (diabetic ketoacidosis)
8. Trauma
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Signs & Symptoms
• Neuromuscular manifestation– Paresthesias & Tetany– bone and joint pain due to calcification– muscle weakness– hyperflexia
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Signs & Symptoms
• Cardiovascular manifestations• Hypotension
– cardiac Dysrythmias– tachycardia
• GI– anorexia– nausea & vomiting
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Nursing Mngt.
• Dietary restriction of foods that are high in phosphate– Hard cheese– Cream– Nuts– Meats– Whole-grain cereals– Dried fruits– Dried vegetables– Sardines– Food made with milk– Poultry
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Nursing Mngt.
• Explain to the patient the importance of a balanced diet.
• Monitor daily food intake• Weight daily• Maintain adequate fluid intake(2-3L/day)• Instruct patient to avoid phosphate containing
substance such as laxatives and enemas.
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Nursing Mngt
Safety• Keep side rails raised, bed in low postion and open
airway(windows) at bedside• Avoid use of restraints• Monitor serum calcium level• Provide a quiet environment and seizure precaution as
appropriate • Administer phosphate binding agents, helpful in lowering
elevated phosphorous levels associated with hypocalcemia.• Teach the patient to recognize signs of impending hypocalcemia
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Medical Mngt.
• Vitamin D preparation such as calcitriol– Oral = Rocaltrol– Parenteral = Calcijex, Paricalcitol (Zemplar)
• Hemodialysis• Phosphate binders• Resin binders– Sevelamer (Renagel)
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Medical Mngt.
• Diuretics• Surgery may be indicated for removal of large
calcium phosphorus deposits
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Diagnostic Test
• Serum CalciumUseful for diagnosing the primary D/O and
assessing the effects of treatment. Serum calcium < 9 mg/dl
• Serum phosphorusSerum phosphorus levels exceeds 4.5 mg/dL in adults, 5.4 mg/dL in children
• Urine phosphorus– < 0.9 g/24 hours
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Nursing Diagnosis
• Knowledge deficit r/t excessive intake of phosphorus and Vit. D
• Decreased cardiac output r/t shifting of fluid from blood to muscles secondary to rhabdomyolysis.
• Imbalanced Nutrition: less than body requirements r/t insufficient intake to meet metabolic demands due episodes of nausea & vomiting, and anorexia.
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Nursing Diagnosis
• Activity intolerance r/t muscle weakness secondary to hyporcalcemia
• Risk for injury r/t increased neural excitability secondary to hypocalcemia
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END
Reference:•Books:
Ignatavicius (2006), Medical Surgical Nursing 5th Edition, volume 1, pg 243Porth, Carol (2005), Pathophysiology 7th Edition, pg 746, 782-783Smeltzer, Suzzane (2008), Brunner & Suddarths Text Book of Medical Surgical Nursing 11th edition, volume 1, pg 331-333
•Internet:•http://Emedicine.medscape.com/article/767010-overview