Treatment includes stopping magnesium sulfate (first step), supportive treatment (intubate if necessary), IV hydration, furosemide, and dialysis as a last resort.

Important points:

1. Hypophosphatemia is seen primarily in patients with diabetic ketoacidosis and alcoholics. Signs and symptoms are neuromuscular disturbances (encephalopathy, weakness), rhabdomy-olysis (especially in alcoholics) and anemia with white blood cell and platelet dysfunction.

2. Hyperphosphatemia is seen almost always in patients with renal failure. Treat with phosphate restriction, dialysis, and phosphate-binding resins (aluminum liydiox.de).

3. In trauma patients, the fluid of choice is Ringer's lactate; the second choice is normal saline.

4. In hypovolemic patients, use normal saline or Riuger'r lactate, regardless of other electrolyte problems.

5. VI,murium, e fluid in NPO patients is usually 5% dextrose in one-half normal saline. In pediatric patients, use ,5% dextrose in one-fourth or one-third normal saline because of renal differences.

6. Add 20 rnEq of potassium chloride to each liter of maintenance fluid in an NPO patient (assuming absence of potassium derangements).

Bj (thiamine).

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