Monobasic and dibasic
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From MedlinePlus, U.S. National Library of Medicine
Dosing in kidney impairment
The maximum initial or single dose of phosphorus is 45 mmol (potassium 66 mEq) [see Warnings and Precautions] . In patients with moderate renal impairment (eGFR ≥30 mL/min/1.73 m 2 to <60 mL/min/1.73 m 2 ), start at the low end of the dose range [see Use in Specific Populations] . Monitor serum phosphorus, potassium, calcium and magnesium serum concentrations. [See table below.] Concentration and Intravenous Infusion Rate
| a In patients with moderate renal impairment (eGFR ≥30 mL/min/1.73 m2 to <60 mL/min/1.73 m2), start at the low end of the dosage range | |
| Patient Population | Generally Recommended Phosphorus Daily Dosage(Potassium Content) |
| Preterm and Term Infants Less than 12 Months | 2 mmol/kg/day(potassium 2.9 mEq/kg/day) |
| Pediatric Patients 1 year to Less Than 12 years | 1 mmol/kg/day; up to 40 mmol/day(potassium 1.5 mEq/kg/day; up to 58.7 mEq/day) |
| Adults and Pediatric Patients 12 Years of Age and Older | 20 mmol/day to 40 mmol/daya(potassium 29.3 mEq/day to 58.7 mEq/day) |
Preparation and administration
Prepare this dose
Your numbers for monobasic and dibasic. Take vial strength, diluent, and limits from the label below.
Enter a dose to see draw volume, final concentration, and rates.
Preparation and Administration in Intravenous Fluids to Correct Hypophosphatemia Preparation
Potassium Phosphates Injection is for intravenous infusion into a central or peripheral vein only after dilution.
Using aseptic technique, withdraw the required amount from the vial and add to 0.9% Sodium Chloride Injection, USP (normal saline) or 5% Dextrose Injection, USP (D5W). For adults and pediatric patients 12 years of age and older a total volume of 100 mL or 250 mL is recommended. For pediatric patients less than 12 years of age, use the smallest recommended volume, considering daily fluid requirements and the maximum concentration for peripheral and central administration shown in Table 1 .
The concentration of the diluted solution should take into consideration the age of the patient, the amounts of phosphorus and potassium in the dose, and is dependent upon whether administration will be through a peripheral or central venous catheter. The recommended maximum concentrations are shown in Table 1 : [See table below.]
Visually inspect the solution for particulate matter and discoloration before and after dilution and prior to administration. Do not administer unless solution is clear, and seal on the vial is intact. Administration
Check serum potassium and calcium concentrations prior to administration. Normalize the calcium before administering Potassium Phosphates Injection [see Contraindications, Warnings and Precautions ( 5.3 , 5.4 )] .
Potassium Phosphates Injection is only for administration to a patient with a serum potassium concentration less than 4 mEq/dL [see Warnings and Precautions] . If the potassium concentration is 4 mEq/dL or more, use an alternative source of phosphorus.
Do not infuse with calcium-containing intravenous fluids [see Warnings and Precautions] .
The rate of administration may be dependent on the patient and the specific institution policy [see Dosage and Administration] . Storage and Stability
Single-Dose Vial (15 mL) o For single use only. Discard used vial, including any unused contents.
After dilution, the solution is stable for a maximum of 4 hours at room temperature 20°C to 25°C (68°F to 77°F) or 14 days under refrigeration at 2°C to 8°C (36°F to 46°F).
Dosage for Administration in Intravenous Fluids to Correct Hypophosphatemia Potassium Phosphates Injection provides phosphorus 3 mmol/mL (potassium 4.4 mEq/mL). The dosage is dependent upon the individual needs of the patient, and the contribution of phosphorus and potassium from other sources. Initial or Single Dose The phosphorus doses in Table 2 are general recommendations for an initial or single dose and are intended for most patients.
Based upon clinical requirements, some patients may require a lower or higher dose. The maximum initial or single dose of phosphorus is 45 mmol (potassium 66 mEq) [see Warnings and Precautions] . In patients with moderate renal impairment (eGFR ≥30 mL/min/1.73 m 2 to <60 mL/min/1.73 m 2 ), start at the low end of the dose range [see Use in Specific Populations] .
Monitor serum phosphorus, potassium, calcium and magnesium serum concentrations. [See table below.] Concentration and Intravenous Infusion Rate
The concentration of the diluted solution [see Table 1 , Dosage and Administration] and the infusion rate is dependent upon whether administration will be through a peripheral or central venous catheter. The maximum recommended infusion rates are shown in Table 3 for adults and pediatric patients 12 years of age and older. [See table below.] Continuous electrocardiographic (ECG) monitoring and infusion through a central venous catheter is recommended for infusion rates higher than:
Potassium 10 mEq/hour for adults and pediatric patients weighing 20 kg or greater
Potassium 0.5 mEq/kg/hour for pediatric patients weighing less than 20 kg Repeated Dosing Additional dose(s) following the initial dose may be needed in some patients. Prior to administration of additional doses, assess the patient clinically, obtain serum phosphorus, calcium and potassium concentrations and adjust the dose accordingly.
Preparation and Administration in Parenteral Nutrition
Potassium Phosphates Injection is for intravenous infusion into a peripheral or central vein only after dilution and admixing .
Potassium Phosphates Injection is to be prepared only in a suitable work area such as a laminar flow hood (or an equivalent clean air compounding area). The key factor in the preparation is careful aseptic technique to avoid inadvertent touch contamination during mixing of solutions and addition of other nutrients.
Transfer the required amount of Potassium Phosphates Injection to the parenteral nutrition solution following the admixture of amino acids, dextrose, electrolytes solutions, and prior to lipids (if added).
Because additives may be incompatible, evaluate all additions to the parenteral nutrition container for compatibility and stability of the resulting preparation.
Calcium and phosphate ratios must be considered. Excess addition of calcium and phosphate, especially in the form of mineral salts, may result in the formation of calcium-phosphate precipitates [see Warnings and Precautions] . Calcium-phosphate stability in parenteral nutrition solutions is dependent upon the pH of the solution, temperature, and relative concentration of each ion.
Discard if any precipitates are observed.
Inspect the final parenteral solution containing Potassium Phosphates Injection to ensure that: o precipitates have not formed during mixing or addition of additives and inspect again before administration. o the emulsion has not separated, if lipids have been added. Separation of the emulsion can be visibly identified by a yellowish streaking or the accumulation of yellowish droplets in the admixed emulsion.
The final parenteral nutrition solution is for intravenous infusion into a peripheral or central vein. The choice of a peripheral or central venous route should depend on the osmolarity of the final infusate. Solutions with osmolarity of 900 mOsmol/L or greater must be infused through a central catheter [see Warnings and Precautions] .
Storage
Protect the parenteral nutrition solution from light during storage . Stability
Single-Dose Vial (15 mL) o For single use only. Discard used vial, including any unused contents. o Use parenteral nutrition solution containing Potassium Phosphates Injection promptly after mixing. Any storage of the admixture should be under refrigeration from 2°C to 8°C (36°F to 46°F) and limited to a brief period of time, no longer than 24 hours.
After removal from refrigeration, bring to room temperature and use promptly and complete the infusion within 24 hours. Discard any remaining admixture.
Dosage for Administration in Parenteral Nutrition Potassium Phosphates Injection provides phosphorus 3 mmol/mL (potassium 4.4 mEq/mL). The recommended daily dosage in parenteral nutrition is shown in Table 4 . Individualize the dosage based upon the patient's clinical condition, nutritional requirements, and the contribution of oral or enteral phosphorus and potassium intake.
The amount of phosphorus that can be added to parenteral nutrition may be limited by the amount of calcium that is also added to the solution. [See table below.] Monitoring Monitor serum phosphorus, potassium, calcium and magnesium concentrations and adjust the dosage accordingly.
| Patient Population | Peripheral Venous Catheter | Central Venous Catheter |
| Adults and Pediatric Patients 12 Years of Age and Older | phosphorus 6.8 mmol/100 mL (potassium 10 mEq/100 mL) | phosphorus 18 mmol/100 mL (potassium 26.4 mEq/100 mL) |
| Pediatric Patients Less than 12 Years of Age | phosphorus 0.27 mmol/10 mL (potassium 0.4 mEq/10 mL) | phosphorus 0.55 mmol/10 mL (potassium 0.8 mEq/10 mL) |
| a Serum phosphorus reported using 2.5 mg/dL as the lower end of the reference range for healthy adults and pediatric patients 12 months of age and older. Serum phosphorus reported using 4 mg/dL as the lower end of the reference range for preterm and term infants less than 12 months of age. Serum phosphorus concentrations may vary depending on the assay used and the laboratory reference range. b Weight is in terms of actual body weight. Limited information is available regarding dosing of patients significantly above ideal body weight; consider using an adjusted body weight for these patients. c up to a maximum of phosphorus 45 mmol (potassium 66 mEq) as a single dose. | ||
| Serum Phosphorus Concentrationa | Phosphorus Dosageb,c | Corresponding Potassium Content |
| 1.8 mg/dL to lower end of the reference rangea | 0.16 mmol/kg to 0.31 mmol/kg | potassium0.23 mEq/kg to 0.46 mEq/kg |
| 1 mg/dL to 1.7 mg/dL | 0.32 mmol/kg to 0.43 mmol/kg | potassium0.47 mEq/kg to 0.63 mEq/kg |
| Less than 1 mg/dL | 0.44 mmol/kg to 0.64 mmol/kgc | potassium0.64 mEq/kg to 0.94 mEq/kg |
| Route of Administration | Maximum Infusion Rate |
| Peripheral Venous Catheter | phosphorus 6.8 mmol/hour (potassium 10 mEq/hour) |
| Central Venous Catheter | phosphorus 15 mmol/hour (potassium 22 mEq/hour) |
Drug interactions
Check monobasic and dibasic against a medication listLabel text (3 paragraphs)
Use of Other Medications that Increase Potassium : Avoid use in patients receiving such products. If use cannot be avoided, closely monitor serum potassium concentrations. ( 5.3 , 7.1 )
7.1 Other Products that Increase Serum Potassium Administration of Potassium Phosphates Injection to patients treated concurrently or recently with products that increase serum potassium (e.g., potassium- sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, digoxin, or the immunosuppressants tacrolimus and cyclosporine) increases the risk of severe and potentially fatal hyperkalemia, in particular in the presence of other risk factors for hyperkalemia [see Warnings and Precautions ( 5.3 )] . Avoid use of Potassium Phosphates Injection in patients receiving such products.
If use cannot be avoided, closely monitor serum potassium concentrations [see Dosage and Administration ( 2.2 , 2.4 )] .
Contraindications
Potassium Phosphates Injection is contraindicated in patients with: • hyperkalemia [see Warning and Precautions ( 5.3 )] • severe renal impairment (eGFR less than 30 mL/min/1.73m 2 ) or end stage renal disease [see Warning and Precautions ( 5.3 )] • hyperphosphatemia [see Warning and Precautions ( 5.4 )] • hypercalcemia or significant hypocalcemia [see Warning and Precautions ( 5.4 )] • hyperkalemia ( 4 ) • hyperphosphatemia ( 4 ) • hypercalcemia or significant hypocalcemia ( 4 ) • severe renal impairment (eGFR less than 30 mL/min/1.73m 2 ) or end stage renal disease ( 4 )
Safety data
Reported adverse events (FAERS)
Liver injury (LiverTox)
LiverTox has no chapter for monobasic and dibasic. Check the label's hepatic warnings.
Pregnancy and lactation
Pregnancy
8.1 Pregnancy Risk Summary Administration of the recommended dose of Potassium Phosphates Injection is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes. Animal reproduction studies have not been conducted with Potassium Phosphates Injection. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations Disease-associated Maternal and/or Embryo-Fetal Risk Phosphorus is an essential mineral element. Parenteral supplementation with potassium phosphates should be considered if a pregnant woman's requirements cannot be fulfilled by oral or enteral intake.
For breastfeeding, also see LactMed (National Library of Medicine), which summarizes milk levels and infant effects.
Supply and cost
Drug shortage status
Recalls (last 24 months)
Therapeutic equivalence (Orange Book)
Price ladder
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