PHOSPHORUS 3.0 -4.

5 Intermediary (go between) in the metabolism of protein, carbs & fats Acid-base buffering-binds with hydrogen, which occurs primarily in urine, making it the primary urinary buffer Acidification of the urine Muscle contraction Transport of fatty acids Proper function of red blood cells Needed for activating vitamins & enzymes, forming ATP for energy supplies & assisting in cell growth & metabolism Reciprocal relationship with Calcium (Low phosphorus=High Calcium; High Phosphorus=Low Calcium) Parathyroid gland controls hormonal regulation of phosphorus by affecting the activity of PTH hormone, PTH also acts on kidneys to increase excretion of phosphorus. Reduced PTH levels allow for phosphorus reabsorption by kidneys, levels rise. Increased PTH levels cause a net loss of phosphorus. High Phosphorus=Low PTH, Low Phosphorus=high PTH Sources: meat, fish, dairy, nuts, eggs, seeds, organ meatsbrain, liver, poultry, whole grains, milk, cheese, yogurt, collard greens, rhubarb, beef, pork HYPOPHOSPHATEMIA Causes: Decreased intestinal absorption (overusage of phosphate binding/aluminum /magnesium based antacids) Renal failure/ Increased renal excretions via kidneys Conditions that cause in an increased shift of phosphorus in the cells (alcoholism, insulin IV, hyperparathyroidism) A lack of phosphate interferes with oxygen transported by RBCs & energy metabolism Increase in Calcium levels Hyperglycemia (causes release of insulin which transports glucose & phosphorus into cells) Inadequate vitamin D intake Chronic diarrhea/laxative abuse Diuretic use (thiazide, loop) Respiratory alkalosis DKA(high glucose levels cause osmotic diuresis Burns Excessive buildup of PTH (PTH stimulates kidneys to excrete phosphorus) Malignancy Hyperalimentation Uncontrolled Diabetes Alcohol Abuse

Cardiac changesdecreased stroke volume & decreased cardiac output. Peripheral pulse is slow & difficult to find & easy to block. Cardiac depression is caused by low stores of intracellular energy, without energy in myocardial cells, contractions are weak & ineffective. Prolonged state causes progressive but reversible cardiac muscle damage. Musculoskeletal changesweak skeletal muscles that may progress to acute muscle breakdown (rhabdomyolysis). Weakness is generalized, paresthesia is NOT present. When muscle weakness becomes profound, respiratory movements are ineffective (respiratory failure) Bone density is decreased leads to fractures & changes in bone shape. CNS changesno apparent until condition is severe. First appear as irritability & may progress to seizure activity, then coma
Signs & Symptoms: Neurologicacute--confusion, seizures, coma; chronicmemory loss, lethargy Decreased strengthacutedifficulty speaking, weakness of respiratory muscles; chroniclethargy, weakness, joint stiffness Decreased myocardial contractilitywith decreased cardiac output & BP Possible bleeding Double vision Malaise Anorexia Weak hand grasps Slurred speech Dysphagia Myalgia (pain/tenderness in muscles) Hemolytic anemia Bruising/bleeding Medical Management: Check phosphate levels Vitamin D supplements Phosphorus IV/oral/enteral tube feedings Check Calcium levels Vital signs Strict I&O Monitor LOC/seizure activity Monitor Calcium + Phosphorus levels Monitor oral & IV phosphate replacementscheck for signs of infiltration at IV site Encourage foods high in Phosphorus Avoid antacids that contain aluminum

Drugs that promote phosphorus loss (antacids, osmotic diuretics, calcium supplements) are D/Cd. oral replacement along with Vitamin D supplement. IV phosphorus is given only when levels are below 1 & patient has serious manifestations. It is given slowly b/c problems with hyperphostemia are equally serious. Nutritional therapyincreasing the intake of phosphorus rich while decreasing in the intake of calcium-rich food
HYPERPHOSPHATEMIA Causes: Dietary changes (oral/IV) Hypoprarthyroidism (lack of PTH) Renal Insuffiency (ERSD)(decreased renal excretion Acidosis (either respiratory or metabolic) Chemo therapy Signs & Symptoms: TetanyTrousseau & Chvostek (d/t low Calcium) Hyperreflexia/Seizure activity Flaccid Paralysis Muscle weakness Tachycardia Nausea Diarrhea Abdominal Cramps Bradycardia Low Urine output CCardiac irregularities HHyperrflexia EEating Poorly MMuscle weakness OOliguria Management: Check Levels Administer Phosphate-binding gels Restrict dietary phosphate Dialysis Correct calcium deficiency (calcium supplements, agents that bind with phosphate in GI tract)