IV Potassium Phosphate and Sodium Phosphate ShortageAdults
Updated June 2013
What? MLH Critical shortage of IV sodium phosphate and IV potassium phosphates
During this critical shortage, the following action plan will be employed:
When: Effective Immediately
Why: IV potassium and sodium phosphates are on shortage and backorder through
the two makers of the product. The resolution date of the shortage is unknown. At
this time, the following shortage plan must be employed.
----------------------------------------------------------------------------------------------Action Plan
1. Adult TPN solutions: Starting 6/11/13, pharmacy will place sodium phosphate
back in TPN without restriction. Pharmacy will manage phosphorus to achieve a low
normal serum level. It is recommended to monitor serum phosphorus for at least
three consecutive days after phosphorus is added back – many of our patients are
candidates for hungry bone disease and may need more than usual supplementation
during the transition.
2. Automatic interchange of IV sodium phosphate/potassium phosphate IV
to oral phosphate
The pharmacist will automatically interchange IV bolus orders to one of the following
oral phosphate regimens if the patient meets all of the following criteria:
•
•
•
Patient able to take medications orally (including patients NPO except
meds)
o Pharmacist will view the patient’s profile for any other active oral
medications and validation of NPO except meds status in Powerchart.
o If the patient does NOT have any other active oral medications on their
profile, pharmacist will process standard IV bolus.
Serum phosphate is greater than or equal to 1 mg/dL
o If the patient serum phosphate is less than 1 mg/dL, pharmacist will
process standard IV bolus
Patient without documented adverse reaction (diarrhea) to oral
phosphate supplementation
o Documentation of adverse reaction must be written in the order
comments for IV sodium phosphate or IV potassium phosphate
o If there is a documented adverse drug reaction with the order,
pharmacist will process standard IV bolus.
Automatic interchange to oral phosphate:
If serum potassium is less than 4.5 mEq/L:
• Automatic interchange to PhosNaK powder 250 mg po q8 hours x 3 doses.
If serum potassium is greater than or equal to 4.5 mEq/L:
• Contact physician for discussion of which oral phosphate product they
would like to prescribe.
Options include:
• PhosNaK powder 250 mg po q8 hours x 3 doses
Note: Each packet contains: 8 mmoles of phosphorus, 6.9 mEq of
sodium, and 7.1 mEq of potassium
OR
• Phospha 250 neutral tablets 250 mg po q8 hours x 3 doses
Note: Less potassium than PhosNaK. Each 250 mg tablet contains: 8
mmoles of phosphorus, 13 mEq sodium, and 1.1 mEq potassium
Suggested monitoring: Repeat phosphate level 8 hours after last dose
3. Standard orders for IV phosphate supplementation:
If patient is not suitable for PO supplementation, pharmacist will process order for
sodium phosphate or potassium phosphate IV and will automatically convert to
standards listed below:
•
•
Any dose of sodium phosphate IV bolus: Dispense sodium phosphate 40
mEq (30 mmoles phosphate) IV x1 dose to infuse over 12 hours
Any dose of potassium phosphate IV bolus: Dispense potassium
phosphate 44 mEq (30 mmoles phosphate) IV x1 dose to infuse over 12
hours
Note: Doses may be given over a shorter time if severe hypophosphemia (<1
mg/dL)
Suggested monitoring: Repeat a serum phosphorus level at least 12 hours after
bolus is completed
4.
Complete depletion of stock of IV potassium phosphate or IV sodium
phosphate for IV boluses:
• If pharmacy stock is depleted of one form of the IV phosphate salts, the
pharmacist will automatically interchange to the remaining form after
review of the patient electrolyte profile.
• Pharmacist will contact prescriber for discussion if patient sodium level is
greater than 148 or potassium greater than 5 (depending on the
interchange), or if additional potassium supplementation is needed by the
patient.
References:
ASHP National Shortages. IV potassium phosphate and sodium phosphate.
Accessed June 2013.
Potassium phosphate and sodium phosphate. Online Lexi Comp drug monograph.
Password protected. Accessed July 19, 2011.
Above action plan approved at August 2011 P&T/MEC.