Let's talk about electrolytes: Phosphorus 

Great question. Presuming you are asking about IV phosphorus provided outside of the PN, you might be looking at options such as a Potassium Phosphorus infusion or the Glycophos commercial product you mentioned. With Potassium Phosphorus and Glycophos, both must be diluted prior to usage. According to the FDA, here's some potassium phos information (link to a PDF here) www.accessdata.fda.gov/drugsatfda_docs/label/2019/212121s000lbl.pdf A few key points: - Administer intravenously only after dilution or admixing in a larger volume of fluid. The concentration of the diluted solution and the infusion rate is dependent upon whether administration will be through a peripheral or central venous catheter. Peripheral administration: - The maximum recommended concentration is phosphorus 6.4 mmol/100 mL (potassium10 mEq/100 mL). - The maximum recommended infusion rate is approximately phosphorus 6.4 mmol/hour (potassium 10 mEq/hour) Central administration: - The maximum recommended concentration is phosphorus 18 mmol/100 mL (potassium 28.2 mEq/100 mL). - The maximum recommended infusion rate is approximately phosphorus 15 mmol/hour (potassium 23.5 mEq/hour). Infusion: "After dilution, the solution is stable for 48 hours under refrigeration at 2°C to 8°C (36°F to 46°F) or at room temperature from 20°C to 25°C (68°F to 77°F)." In terms of Glycophos, here is a statement from the American Society of Parenteral and Enteral Nutrition (ASPEN): www.nutritioncare.org/News/General_News/FDA_Approves_Temporary_Importation_of_Glycophos/ A few notes here: "Glycophos is an ORGANIC phosphate which is a different type of phosphate than the INORGANIC phosphate injection products currently marketed in the U.S. Organic phosphates tend to be more calcium compatible. Glycophos contains 1 mmol of phosphate per 1 mL of solution as compared to the phosphates currently marketed in the U.S. which contain 3 mmol of phosphate per 1 mL." That being said, you would require more mLs to get the same amount of phosphate using Glycophos compared to other products marketed in the U.S. Looking to timing of infusion, from the manufacturer information here www.fresenius-kabi.com/nz/documents/Glycophos_Datasheet.pdf (link to PDF) It appears that infusion time should not be less than 8 hours for this product. Infusion limits and guidance is typically described on commercial product information and those guidelines should be used when administering products, as well as professional guidance from your institution and other essential members of this team such as the physicians and pharmacists working with your care team. This information is meant to be for reference only and should NOT be used in replacement of personalized nutrition therapies from a qualified care provider. Hopefully all this helps!

Very informative. Thanks a lot.

Hi, thanks for asking! Those are intended to be daily recommendations.

As discussed in the video, the normal range for phosphorus is between 2.5-4.5 mg/dL. Keep in mind that different institutions may have their own recommended range for phosphorus that is likely very close to this range if not the same.

Great question! In particular, it is the two salt (phos and calcium) combo that leads to the precipitation. One RDN on our team mentioned that if the PN is short term, they may sacrifice the calcium and remove it completely from the bag so they can increase the phos content to provide more to the patient.

@@DietitiansinNutritionSupport Thank you so much! I pull the calcium out sometimes to increase the phos, but started to get worried I was still creating a potential risk.