sodium phosphates, IV (Rx)

Frequency Not Defined

Sodium

• Anorexia
• Nausea
• Vomiting
• Fatigue
• Irritability
• Lethargy
• Confusion
• Stupor
• Coma
• Muscle twitching
• Hyperreflexia
• Spasticity
• Tremor
• Ataxia

Phosphorus

• Hypocalcemic tetany

Contraindications

Hyperphosphatemia

Hypocalcemia

Hypernatremia

Cautions

Must be diluted and thoroughly mixed before administration

Phosphorus replacement therapy with sodium phosphates should be guided primarily by the serum inorganic phosphorus levels and the limits imposed by the accompanying sodium (Na+) ion

To avoid hypernatremia or hyperphosphatemia, infuse IV solutions containing sodium phosphates slowly

Caution with severe renal or adrenal insufficiency due to risk for hypernatremia or hyperphosphatemia; in patients with diminished renal function, administration of solutions containing sodium ions may result in sodium retention

Use with great care, if at all, in patients with congestive heart failure, cirrhosis, severe renal insufficiency, and other edematous conditions associated with sodium retention

High concentrations of phosphorus may cause hypocalcemia and hypocalcemic tetany; monitor calcium levels

Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions, to patients receiving corticosteroids or corticotropin

Aluminum toxicity

• This product contains aluminum that may be toxic; aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired; premature neonates are at particular risk because of immature kidneys; they require large amounts of calcium and phosphate solutions, which contain aluminum
• Aluminum doses exceeding 4-5 mcg/kg/day are associated with CNS and bone toxicity
• Tissue accumulation may occur at even lower doses

Pregnancy

Animal reproduction studies not conducted with sodium phosphate; also not known whether sodium phosphate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; sodium phosphate should be given to a pregnant woman only if clearly needed

Lactation

Phosphorus and sodium are normal components of human milk; decision to administer during breastfeeding should take into account risk of infant exposure, benefits of breastfeeding to infant, and benefits of therapy to mother

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Phosphorus is involved in many biochemical functions in the body and significant metabolic and enzyme reactions in almost all organs and tissues; it exerts a modifying influence on the steady state of calcium levels, a buffering effect on acid-base equilibrium, and a primary role in the renal excretion of hydrogen ion

Sodium is the principal cation of extracellular fluid and comprises >90% of the total cations in the body; it is critical to regulating extracellular and intravascular volume

Elimination

Excretion: feces (10%), urine (90%)

IV Incompatibilities

Calcium and phosphorous are incompatible and will precipitate in most aqueous solutions; may be mixed in some TPN admixtures in variable quantities depending on the composition of the preparation, order of mixing, pH, temperature, storage, and particular calcium salt (consult pharmacist)

Y-Site Administration

• Acyclovir, amiodarone, amphotericin B lipid complex (Abelcet), amphotericin B liposome (AmBisome), anidulafungin, caspofungin, ciprofloxacin, daunorubicin liposome, doripenem, doxacurium, doxorubicin, epirubicin, gemtuzumab ozogamicin, idarubicin, ifosfamide, ketamine, lansoprazole, leucovorin calcium, lorazepam, mitoxantrone, mycophenolate, pantoprazole, quinupristin/dalfopristin, rocuronium

Admixture

• Ciprofloxacin, dobutamine

Syringe

• Aminophylline, pantoprazole, salbutamol

For Dilution

• D10% in 0.9% NaCl; D2.5% in Half-strength LR; D5% in LR; Dextrose 5% in Ringer's; Lactated Ringer's; Ringer's injection

IV Compatibilities

Y-Site Administration

• Alemtuzumab, aminocaproic acid, argatroban, atenolol, bivalirudin, bleomycin, carboplatin, carmustine, cisplatin, cyclophosphamide, cytarabine, dactinomycin, daptomycin, dexmedetomidine, dexrazoxane, diltiazem

Admixture

• Magnesium sulfate, metoclopramide, verapamil

For Dilution

• Dextran 70 6% in D5W; dextran 70 6% in 0.5% NaCl; D10W; D2.5W; D2.5/0.45% NaCl; D5/0.2% NaCl; D5/0.45% NaCl; D5/NS; 0.9% NaCl (NS); 0.45% NaCl; sodium lactate 1/6 M

IV Administration

Do not administer unless solution is clear and seal is intact; discard unused portion

Administered IV only after dilution in a larger volume of fluid

Administer slowly over 4-6 hr

Storage

Store at 20- 25°C (68- 77°F); excursions permitted to 15-30°C (59-86°F)

Does not contain a bacteriostatic agent or other preservatives; discard any unused portion