towards safer phosphate repletion: a 24-hour weight-based infusion protocol for hypophosphatemic icu patients

Background: evidence on the safety and efficacy of phosphate (p) replacement in hypophosphatemic intensive care unit (icu) patients remains limited.objectives: to evaluate the efficacy and safety of a 24-hour weight-based intravenous phosphate replacement protocol.methods: adult icu patients with hypophosphatemia received potassium acid phosphate (25 ml) diluted in 500 ml of saline or 5% glucose, administered via infusion pump. dosing was 0.3 mmol/kg/24 h for mild hypophosphatemia (0.65 - 0.73 mmol/l) and 0.6 mmol/kg/24 h for moderate to severe cases (≤ 0.64 mmol/l). phosphate levels were measured every 24 hours. efficacy was defined as normalization of phosphate within 24 hours. safety outcomes included hypocalcemia, hypotension, hyperphosphatemia, hyperkalemia, and acute kidney injury.results: among 134 patients (aged 67.6 ± 14.6 years; 55% female; median apache ii median 18), 197 hypophosphatemia episodes were treated. phosphate normalized within 24 hours in 121 episodes (61%). mild adverse events occurred in 28 patients (21%); no severe complications were reported.conclusions: this protocol is not a replacement for standard guidelines in symptomatic hypophosphatemia and unstable patients. it proved effective and generally safe in critically ill patients with mild to severe hypophosphatemia, offering a feasible approach in resource-limited icu settings where oral formulations are unavailable and frequent laboratory monitoring is unfeasible.