Hyperphosphataemia

1. Is the patient unwell?

• ABCDE approach 

2. Is the result a true value?

• Could the sampling method have affected the result?
• Is there a previous level?

3. Does the patient have any symptoms or signs?

• May indicate the significance and rapidity of electrolyte change
• Itching, nausea, tetany
• Hyperphosphataemia itself is generally asymptomatic and symptoms are often due to coexisting hypocalcaemia - check for this

4. Are there culprit drugs? - consider stopping them

• Bisphosphonates, phosphate enemas, vitamin D, liposomal amphotericin B

5. Causes? - treat them

• Acid-base disorder, magnesium deficiency, renal failure, tumour lysis syndrome, rhabdomyolysis, high lipid myeloma, hyperbilirubinaemia

• Treat associated electrolyte derangement
• Treat nausea and itching with symptomatic relief
• If associated with CKD – contact renal team – phosphate binder and dietary change may be required
• Specific treatment not required

Seek senior advice if concerns and in particular if:

• Hyperphosphataemia in the context of renal failure – contact renal team for advice

Cardiac monitoring or HDU review?

• Cardiac monitoring or HDU review needed only if clinical concern and only if patient a candidate for escalation of care