DefinePK

Abstract

Background: Phosphorus disorders, including hypophosphatemia and hyperphosphatemia, are common in critically ill patients with acute kidney injury and contribute to adverse outcomes. Standard dialysis solutions often exacerbate hypophosphatemia, necessitating innovative strategies like phosphorus-enriched dialysate for safer management.
Objective: To evaluate the use of Sodium Phosphate Rectal Enema in preparing phosphorus-enriched dialysate for acute dialysis in critically ill patients with hypophosphatemia.
Study type, settings & duration: This prospective cohort study was done at Intensive Care Unit (ICU), Liaquat National Hospital, Karachi from May 2021 to April 2023.
Methodology: A total of 100 critically ill patients with acute kidney injury, all with serum phosphorus levels below 2.0 mg/dl and undergoing hemodialysis for acute indications, were included in the study. Sodium Phosphate Rectal Enema was added to the bicarbonate component of the dialysate solution, and phosphorus levels in the finalized dialysate (prepared by mixing acetate and bicarbonate solutions) were measured. Serum phosphorus levels were then measured again following the completion of hemodialysis. Serum calcium level pre/post-dialysis and ECG monitoring for arrhythmias were performed to assess safety.
Results: Sodium Phosphate Rectal Enema was used in volumes of either 60 mL or 120 ml. The mean ± standard deviation (SD) pre-hemodialysis serum phosphorus level was 1.77±0.377 mg/dl. The mean±SD post-hemodialysis serum phosphorus level was significantly increased to 3.0±0.909 mg/dl (p-value <0.0001). There was an insignificant difference in pre and post hemodialysis serum calcium levels as 8.57±0.27 and 8.51±0.29 mg/dl respectively (p-value:0.14689).
Conclusion: Sodium Phosphate Rectal Enema can be effectively used to prepare phosphorus-enriched dialysate, .......