Hypophosphatemia

Early recovery pathway for hepatectomy: data-driven liver resection care and recovery

“…Pomposelli showed that more aggressive post-operative TPN with twice the RDA of phosphorus (60 vs. 35 mmol/d) resulted in half the incidence of complications in patients undergoing right hepatic lobectomy for live donor adult transplantation, although serum phosphorus levels were not reported in their study (32 Hypophosphatemia occurring post-hepatic resection has been well documented in previous studies (30)(31)(32)(33). A number of physiologic changes contribute to the hypophosphatemia including the need for intracellular phosphorous in hepatocellular cell growth (34,35) and post-operative disturbances in hepatorenal messaging, driving significant urinary losses of phosphate by a rise in a phosphatonin (36). Phosphate is an essential element for physiological homeostasis.…”

“…Phosphate is an essential element for physiological homeostasis. The phosphate anion plays an important role in the formation of high-energy bonds essential for nucleotide synthesis, growth and repair of tissues, and the stability of the cell membrane (34). In addition, phosphate is essential for the proper function of red blood cells, platelets, and oxygen release from oxyhemoglobin (34).…”

“…The phosphate anion plays an important role in the formation of high-energy bonds essential for nucleotide synthesis, growth and repair of tissues, and the stability of the cell membrane (34). In addition, phosphate is essential for the proper function of red blood cells, platelets, and oxygen release from oxyhemoglobin (34). As such, post-operative hypophosphatemia has been linked to postoperative complications, including impaired diaphragmatic contractility, hemolytic anemia, myocardial depression, and glucose intolerance by insulin depression (34,35).…”

“…In addition, phosphate is essential for the proper function of red blood cells, platelets, and oxygen release from oxyhemoglobin (34). As such, post-operative hypophosphatemia has been linked to postoperative complications, including impaired diaphragmatic contractility, hemolytic anemia, myocardial depression, and glucose intolerance by insulin depression (34,35).…”

“…S a f e supplementation has been suggested at 15 mmol of IV sodium or potassium phosphate infused over 2-6 hours and repeated 2-3 times in 24 hours (30,34). However, overaggressive phosphate repletion has been linked to complications such as renal failure, hypocalcemic tetany, hypotension, and cardiac arrhythmias (31,34,37). Since complication rates were observed in our study in cases where supplementation exceeded the recommended 45 mmol/d dose of supplementation, hyperphosphatemia may have been the cause of complications.…”