Grave ipofosfatemia in terapia intensiva.

Translated title of the contribution: Severe hypophosphatemia in intensive care

C. Iermano, L. Ughi, F. Aloj, M. Giurbino, M. Pezza

Research output: Contribution to journalArticle

Abstract

Phosphorus plays an essential role in cellular metabolism, especially in the oxidative phosphorylation process and in the synthesis of 2-3 DPG and membrane phospholipids. Moreover phosphorus is necessary as a buffer, mainly when the organism's principal buffer, the H2CO3/HCO3- system, is working at maximal rate. The authors describe a case of severe hypophosphatemia in a ICU patient with a mixed disorder of the acid-base balance. C.P., a woman, aged 71, obese (IBW 145%), at admission in ICU showed increasing dyspnea, hypoxemia and acidosis. Besides alkaline drugs a Venturi mask with FiO2 = 0.3 alternated to CPAP cycles (7 cm H2O) with facial mask applied. Bading on CVP, MAP and ABG results, a pharmacologic therapy with enoximone, furosemide, bronchodilators, mucolytics, antacids, antibiotics and inotropics was performed. TPN with only essential amino acids was performed, in order to activate lipolysis and ketogenesis; but the ABG showed over again mixed disorder of acid-base balance (metabolic and chronic respiratory acidosis), only partially leading to ketogenesis. The reduction of the hematic HCO3-, without changes of PaCO2, was justified by the blood lactic acid of 6.2 mmol/L. And what about blood lactic acid increase? During patient hospitalization, the hematic phosphorus had decreased to, 0.8 mg/dl. Diuretic therapy together with acidosis tamponage, and reduced phosphorus feed had been responsible of severe hypo-phosphatemia. Therapy adjustments brought the phosphatemia to normal values and to a substantial improvement of clinical conditions.

Original languageItalian
Pages (from-to)43-46
Number of pages4
JournalMinerva Anestesiologica
Volume61
Issue number1-2
Publication statusPublished - Jan 1995

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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Iermano, C., Ughi, L., Aloj, F., Giurbino, M., & Pezza, M. (1995). Grave ipofosfatemia in terapia intensiva. Minerva Anestesiologica, 61(1-2), 43-46.