Treatment of hyperphosphatemia Significant hyperphosphatemia (phosphate level >>5 mg/dL or >1.6 mM) If ongoing renal failure with persistent hyperphosphatemia, consider: Acute treatments - Phosphate restricted diet - Remove any treatable causes (e.g. offending medications such as Vitamin D) - Fluid resuscitate to euvolemia - For acute/severe hyperphosphatemia consider forced diuresis (with acetazolamide +/ - furosemide), or dialysis Success If no persistent hyperphosphatemia, youāre all set. Calcium acetate - 667 mg, two tablets TID with meals Occasional patients with both significant hypocalcemia and Ca - Phos product << 70 Sevelamer - 800 mg TID with meals, double dose PRN - Check for drug interactions (adsorbs some PO meds ) Most patients Oral phosphate binder - Use in ongoing renal failure - Doesnāt achieve immediate control; may prevent ongoing worsening of hyperphosphatemia The Internet Book of Critical Care, by @PulmCrit If ineffective may consider