Phosphorus is a mineral that naturally occurs in many foods and is also available as a supplement. It plays multiple roles in the body. It is a key element of bones, teeth, and cell membranes. It helps to activate enzymes, and keeps blood pH within a normal range

1. REHANA KAUSAR
Student
Post RN- 1ST Year

2. Objective of lecture
At the end of this session, the students will be able to:
 Define hyperphosphatemia
 Causes of excessive phosphorous in body.
 Distinguish the patients with sign and symptoms.
 Lab Assessment and diagnosis
 Medical and surgical treatment
 Nursing supportive management

3. Phosphorous
 Phosphorous is a critical constituent(electrolyte) of all
body tissues.
 Primary anion of ICF
 Essential for functions of muscles and red blood cells.
 Support to maintain acid base balance
 Assists in metabolism of carbohydrates ,protein and fats.
 The normal serum phosphorous level in 2.5 to 4.5
mg/dL(0.8 to 1.45mmol/L) in adults.
 85% in bones and teeth,14% in soft tissues and less than 1%
in ECF

4. Phosphorous imbalance
Hypophosphatemia :Phosphorous deficit or value
below 2.5mg/Dl(0.8mmol/L)
 Hyperphosphatemia: phosphorous excess or serum
level increase 4.5mg/Dl(1.45mmol/L)

5. Hyperphosphatemia
Pathology
contributing factors
Clinical manifestations
Signs and symptoms
•Acute kidney injury and CKD
•Excessive intake of phosphorous
•Due to increased level of Vit-D
•Acidosis, respiratory and
metabolic
•Hyperparathyroidism
•Volume depletion
•Leukemia/lymphoma treated
with cytotoxic agents
•Increased tissue breakdown
•Rhabdomyolysis.
•Tetany
•Tachycardia
•Anorexia
•Nausea and vomiting
•Muscles weakness
•Signs and symptoms of
hypocalcaemia
•Hyperactive reflexes
•Soft tissue calcification in
lungs, heart kidney and
cornea.

6. Assessment and diagnostic
findings
On laboratory:
 Serum phosphorous level exceed 4.5mg/Dl(1.5mmol/L)
 Serum calcium level is useful for diagnosing the primary
disorder and assessing the effects of treatment.
 PTH level decreased due hyperparathyroidism
 BUN and Creatinine level used to assess renal functions.
X-ray:
 X-ray shows skeletal changes with abnormal bone
development.

7. Medical management
Treatment is directed at underline disorders
 Management of respiratory or metabolic acidosis, kidney injury,
elevated PTH production and bone disease etc..
 Measure phosphorous level in blood to decrease at normal range.
 Restriction of dietary phosphate.
 Administration of Calcitriol(oral or parenteral)
 Administration of Amphojel with meal is also effective but long term
use can cause bone and central nervous system toxicity.
 Forced diuresis with a loop diuretic , volume replacement with saline
 Dialysis may lower phosphorous
Surgery may indicated for removal of large calcium and
phosphorous deposits.

8. Nursing Management
 Continuous monitoring of patients at risk for
hyperphosphatemia.
 The patient is guided to avoid food with rich amount
of phosphorous such as hard cheeses, cream, nuts,
meat, whole grains, cereal ,dried fruits, dried
vegetables, kidneys, sweetbreads and food dairy food
or milk products.
 Nurse instructs the patients to avoid phosphate
containing laxatives and enemas.
 The nurse also educate the patient to recognize the
signs and symptoms of hypocalcaemia and monitoring
the changes in urine output

9. Questions
are
invited