Pharmacologic Highlights

Medication or

Drug Class Dosage



Phosphate supplements

Oral: 0.5-1.0 g elemental phosphorus PO bid-tid IV: Phosphate infusion IV over 6 hr

Oral: Neutra-Phos (250 mg phosphorus and 7 mEq each of sodium and potassium); Neutra-Phos K (250 mg phosphorus and 14 mEq sodium); IV: Potassium phosphate and sodium phosphate, 2.5-5.0 mg/kg in 500 mL 0.45% saline solution

Replace phosphorus; often capsules are preferred because the tablet form may cause nausea; if the deficit is severe, IV infusion of potassium phosphate is needed

Note that the response to IV phosphorus supplementation Is variable and may lead to hyperphosphatemia and hypocalcemia. When using potassium phosphate as a supplement, monitor the potassium level and note that hyperkalemia may limit amount of phosphate that can be given safely.

Other Drugs: Analgesics may be ordered for bone pain. Monitor the effectiveness of the pain medications. Avoid administering antacids that contain aluminum. If the patient develops alcohol withdrawal, the treatment of choice is the benzodiazepine class of medications.


Maintain an open airway and adequate breathing. Keep an artificial airway, manual resuscitator bag, and suction at the bedside at all times. If you hear stridor or see respiratory distress, notify the physician immediately, insert an oral or nasal airway if appropriate, and keep the airway clear with oral or nasal suction. If the patient is unresponsive, use the jaw lift or chin thrust to maintain the airway until a decision is made whether to intubate the patient.

Maintain a safe environment. The patient may need assistance with ambulation and activities of daily living. Orient the patient as needed. Encourage patient involvement in self-care as much as possible. If the patient develops signs of alcohol withdrawal (restlessness, insomnia, thirst, and tremors progressing to fever, hallucinations, and combative and irrational behavior), notify the physician and decrease stimulation as much as possible. Place the patient in a quiet, darkened room with a cool temperature. Provide frequent sips of water and fruit juices, but avoid fluids with caffeine. Place the patient in a room where she or he can be monitored frequently to decrease the risk of injury.

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