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Enteral Phosphate Replacement in the Intensive Care Unit.

Kayla M Wesley1,2, Ji Tong Liu1,3, Chelsea Wampole1

  • 1Department of Pharmacy, MaineHealth Maine Medical Center, Portland, ME, USA.

The Annals of Pharmacotherapy
|April 20, 2026
PubMed
Summary
This summary is machine-generated.

Enteral phosphate replacement is safe and effective for critically ill patients with hypophosphatemia. This study compared dosing strategies, finding enteral phosphate a viable alternative to intravenous administration.

Keywords:
enteral phosphatehypophosphatemiaphosphatephosphorus

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Clinical Nutrition

Background:

  • Enteral phosphate replacement offers advantages over intravenous methods.
  • Optimal enteral phosphate dosing and administration remain unclear for hypophosphatemia.

Purpose of the Study:

  • Compare two enteral phosphate dosing strategies (PRE vs. POST) for mild hypophosphatemia.
  • Evaluate enteral phosphate dosing for moderate hypophosphatemia in critically ill patients.

Main Methods:

  • Single-center, quasiexperimental study in an ICU setting.
  • Included 138 adult patients receiving enteral phosphate replacement.
  • Compared mild hypophosphatemia groups (48 mmol PRE vs. 72 mmol POST) and a moderate group (72 mmol).

Main Results:

  • Serum phosphorus normalization occurred in 58.2% (mild PRE) and 72.7% (mild POST) of patients.
  • Phosphorus levels increased by 0.4 mg/dL (mild PRE) and 0.7 mg/dL (mild POST).
  • Normalization occurred in 66.7% of the moderate group, with a 1.0 mg/dL phosphorus increase.

Conclusions:

  • Enteral phosphate replacement is safe and effective for mild-to-moderate hypophosphatemia.
  • It serves as a potential alternative to intravenous phosphate therapy in critically ill patients.