HEMODYNAMIC AND METABOLIC EFFECTS OF RAPID CORRECTION OF HYPOPHOSPHATEMIA IN PATIENTS WITH SEPTIC SHOCK

Study objective: To examine the hemodynamic and metabolic short-term e ffects of hypophosphatemia correction in patients with septic shock re ceiving catecholamine therapy. Design: Prospective, single cohort stud y. Setting: ICU, university hospital. Patients: Ten patients with sept ic shock and hypophosphatemia below 2 mg/dL. Interventions: Infusion o f glucose-1-phosphate solution (20 mmol of elemental phosphorus) for 6 0 min. Measurements and results: Hemodynamic, oxygen-derived, acid-bas e, and electrolyte parameters before and immediately after phosphate i nfusion. Left ventricular stroke work index increased significantly (2 2%) from a mean low value of 24 +/- 10 g/m(2) without changes in filli ng pressures. Systolic arterial pressure improved by 12%. Arterial pH improved slightly but significantly. Ionized calcium level slightly de creased within the normal range values. Other parameters remained unch anged. Conclusions: Severe hypophosphatemia may be considered as a sup erimposed cause of myocardial depression, inadequate peripheral vasodi latation, and acidosis in septic shock. A rapid correction of hypophos phatemia is well tolerated and may have both myocardial and vascular b eneficial effects. The magnitude of the response, however, is variable and unpredictable on the basis of serum phosphorus levels.