BNF for Children 2011-2012

BNFC 2011–2012 9.5.2 Phosphorus 475Phosphate is not the first choice for the treatment ofhypercalcaemia because of the risk of precipitation ofcalcium phosphate in the kidney and other tissues. Ifused, the child should be well hydrated and electrolytesmonitored.Neonates Phosphate deficiency may occur in verylow-birthweight infants and may compromise bonegrowth if not corrected. Parenterally fed infants maybe at risk of phosphate deficiency due to the limitedsolubility of phosphate. Some units routinely supplementexpressed breast milk with phosphate, althoughthe effect on the osmolality of the milk should beconsidered.PHOSPHATECautions see notes above, also cardiac disease, diabetesmellitus, dehydration; avoid extravasation withparenteral forms, severe tissue necrosis; sodium andpotassium concentrations of preparationsRenal impairment reduce dose; monitor closelySide-effects nausea, diarrhoea; hypotension, oedema;hypocalcaemia; acute renal failure; phlebitis; tissuenecrosis on extravasationIndication and doseHypophosphataemia, including hypophosphataemicrickets and osteomalacia (see notes above). By mouthNeonate 1 mmol/kg daily in 1–2 divided doses, oras a supplement in breast milkChild 1 month–5 years 2–3 mmol/kg (max.48 mmol) phosphate daily in 2–4 divided doses,adjusted as necessaryChild 5–18 years 2–3 mmol/kg (max. 97 mmol)phosphate daily in 2–4 divided doses, adjusted asnecessaryAdministration Caution, solubility in breast milk is limitedto 1.2 mmol in 100 mL if calcium also added, contactpharmacy department for details. By intravenous infusion (see administrationbelow and seek specialist advice)Neonate 1 mmol/kg phosphate daily, adjusted asnecessaryChild 1 month–2 years 0.7 mmol/kg phosphatedaily, adjusted as necessaryChild 2–18 years 0.4 mmol/kg phosphate daily,adjusted as necessaryAdministration (see also Important, below) Diluteinjection with Sodium Chloride 0.9% or 0.45% or Glucose5% or 10%. Administration rate of phosphate should notexceed 0.05 mmol/kg/hour. In emergencies in intensivecare faster rates may be used—seek specialist adviceImportantSome phosphate injection preparations also containpotassium. For peripheral intravenous administrationthe concentration of potassium should not usuallyexceed 40 mmol/litre. The infusion solution shouldbe thoroughly mixed. Local policies on avoidinginadvertent use of potassium concentrate should befollowed. The potassium content of some phosphatepreparations may also limit the rate at which they maybe administered, see section 9.2.2.1.OralPhosphate-Sandoz c (HK Pharma)Tablets, effervescent, anhydrous sodium acid phosphate1.936 g, sodium bicarbonate 350 mg, potassiumbicarbonate 315 mg, equivalent to phosphorus 500 mg(phosphate 16.1 mmol), sodium 468.8 mg (Na +20.4 mmol), potassium 123 mg (K + 3.1 mmol). Netprice 20 = £3.29. Label: 13Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Various strengths and salts available, caution electrolyteloadInjectionPhosphates (Fresenius Kabi) AIntravenous infusion, phosphates (providing phosphate100 mmol/litre, potassium 19 mmol/litre, sodium162 mmol/litre), net price 500 mL (Polyfusor c )=£3.75.Potassium acid phosphate (Non-proprietary) AInjection, 13.6% (1 mmol/mL phosphate, 1 mmol/mL potassium) 10 mL ampouleNote See also Important, aboveDipotassium hydrogen phosphate (Non-proprietary)AInjection, 17.42% (1 mmol/mL phosphate and2 mmol/mL potassium) 10 mL ampouleNote See also Important, aboveDisodium hydrogen phosphate (Non-proprietary) AInjection, 17.42% (0.6 mmol/mL phosphate and1.2 mmol/mL sodium) 10 mL ampoule9.5.2.2 Phosphate-binding agentsCalcium-containing preparations are used as phosphate-bindingagents in the management of hyperphosphataemiacomplicating renal failure. Aluminiumcontainingpreparations are rarely used as phosphatebindingagents and can cause aluminium accumulation.Sevelamer hydrochloride is licensed for the treatmentof hyperphosphataemia in adults on haemodialysis orperitoneal dialysis. Although experience is limited inchildren sevelamer may be useful when hypercalcaemiaprevents the use of calcium carbonate.ALUMINIUM HYDROXIDECautions see notes above; interactions: Appendix 1(antacids)Side-effects constipation; hyperaluminaemiaAlu-Cap c (Meda)Capsules, green/red, dried aluminium hydroxide475 mg (low Na + ), net price 120-cap pack = £3.75DoseHyperphosphataemia. By mouthChild 5–12 years 1–2 capsules 3–4 times daily, adjustedas necessaryChild 12–18 years 1–5 capsules 3–4 times daily,adjusted as necessary9 Nutrition and blood