poe-TASS-ee-um AS — id FOS-fate

Therapeutic Classification: antiurolithics

• Adjunct therapy of urinary tract infections with methenamine hippurate or mandelate.
• Prevention of calcium urinary stones.

• Serves as a buffer for the excretion of hydrogen ions by the kidney.
• Dibasic potassium phosphate is converted in renal tubules to monobasic salt by hydrogen ions, resulting in urinary acidification.
• Acidification of urine is required for methenamine hippurate or mandelate to be active as a urinary anti-infective.
• Acidification of urine increases solubility of calcium, decreasing calcium stone formation.

• Urinary acidification.
• Increased efficacy of methenamine.
• Decreased formation of calcium urinary tract stones.

Absorption: Well absorbed following oral administration.

Distribution: Phosphates enter extracellular fluids and are then actively transported to sites of action.

Metabolism/Excretion: Excreted mainly (>90%) by the kidneys.

Half-life: Unknown.

Contraindicated in:

• Hyperkalemia
• Hyperphosphatemia
• Hypocalcemia
• Hypomagnesemia
• Severe renal impairment.

Use Cautiously in:

• Metabolic alkalosis
• Cardiac disease
• Renal impairment
• Children (safety and effectiveness not established).

Related to hyperphosphatemia, unless otherwise indicated

CNS: confusion, listlessness, weakness.

CV: ARRHYTHMIAS, CARDIAC ARREST, ECG changes (absent P waves, widening of the QRS complex with biphasic curve), hypotension.
hyperkalemia: ARRHYTHMIAS, bradycardia, ECG changes (prolonged PR interval, ST segment depression, peaked T waves).

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting.

F and E: hyperkalemia, hyperphosphatemia, hypocalcemia, hypomagnesemia.

MS: muscle cramps, tremors.

Neuro: flaccid paralysis, heaviness of legs, paresthesias.

Drug-Drug:

• Concurrent use of potassium-sparing diuretics, ACE inhibitors, angiotensin receptor blockers, or aldosterone antagonists may result in hyperkalemia.
• Concurrent administration of calcium- or aluminum- containing compounds or sucralfate decreases absorption of phosphates by formation of insoluble complexes.

Drug-Food:

• Oxalates (in berries, nuts, chocolate, beans, celery, and tomatoes) and phytates (in bran and whole grains) may decrease the absorption of phosphates by binding them in the GI tract.

• PO (Adults): 1 g (7.4 mmol) in 6–8 oz of water 4 times daily with meals and at bedtime.

• Tablets for oral solution: 500 mg (contains 3.7 mmol phosphorus);

• Monitor intake and output ratios and daily weight. Report significant discrepancies.

• Monitor serum phosphate, potassium, and calcium levels prior to and periodically throughout therapy. Increased phosphate may cause hypocalcemia.
  • Monitor renal function prior to and periodically throughout course of therapy.
  • Monitor urinary pH when using as a urinary acidifier.

• Symptoms of toxicity are those of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QT segments, widened QRS complexes, loss of P waves, and cardiac arrhythmias) and hyperphosphatemia or hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, or Chvostek’s or Trousseau’s sign).
  • Treatment includes discontinuation of infusion, calcium replacement, and lowering serum potassium (dextrose and insulin, sodium bicarbonate, or albuterol to facilitate passage of potassium into cells, sodium polystyrene sulfonate as an exchange resin, and/or dialysis in patients with impaired renal function).

• PO: Tablets should be dissolved in 6–8 oz of water. Allow mixture to stand for 2–5 min to ensure that it is fully dissolved.
  • Medication should be administered with meals to minimize gastric irritation and risk of diarrhea.
  • Do not administer simultaneously with antacids containing aluminum, magnesium, or calcium.

• Explain to patient purpose of the medication and the need to take as directed. If a dose is missed, it should be taken as soon as remembered unless within 1–2 hr of the next dose. Explain that the tablets should not be swallowed whole. Tablets should be dissolved in water.
• Advise patient of the importance of maintaining a high fluid intake (drinking at least one 8-oz glass of water each hr) to prevent kidney stones.
• Instruct the patient to report diarrhea, weakness, fatigue, muscle cramps, or tremors promptly.

• Maintenance of acid urine.
• Decrease in urine calcium, which prevents formation of renal calculi.

K-Phos Original

• Imbalanced nutrition: less than body requirements (Indications).