Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54

796 Hypophosphatemia Hypopituitarism

Naphosph or Kphosph; choice dictated by other illnesses such as

heart or renal failure.

■Goal of therapy: provide 1,000 mg (32 mM)/day of elemental phos-

phorus with max of 3,000 mg/day

■Oral: skim milk (1,000 mg/quart), whole milk (850 mg/quart), Neu-

traphosph K capsules, Neutraphosph solution

■Intravenous: Kphosphate, Na phosphate. Do not exceed 2 mg phos-

phorus/kg body weight q6h to avoid metastatic calcification.

■In hyperalimentation:To avoid refeeding syndrome, make sure have

450 mg phosphorus for each 1,000 kcal infused

■Side effectsinclude diarrhea, hyperphosphatemia, hypocalcemia,

and hyperkalemia (with Kphosph preparations)

follow-up

■Measure phosphorus levels as trough values for oral replacement.

Frequent measurement of phosphorus and calcium levels should

be done with IV therapy to avoid toxicity, but peak levels may be

false-positive indicator of actual body stores.

complications and prognosis

■Prognosis is good with therapy.

Hypopituitarism.....................................

ANDREW R. HOFFMAN, MD

history & physical

History

■Weakness, weight loss

■Infertility

■Amenorrhea or oligoamenorrhea

■Postpartum hemorrhage, recent pregnancy

■Autoimmune disease

■History of pituitary tumor, surgery, apoplexy, or irradiation

■History of traumatic brain injury

■CNS irradiation

■Head trauma

■Craniopharyngioma, dysgerminoma

■Metastatic breast and lung cancer

■Histiocytosis X, sarcoidosis, TB

■Absent or delayed puberty