Background: Evidence-based guidelines for monitoring of
serum phosphate levels and for the treatment of hypophosphataemia in critically ill patients are lacking. The aim of this survey was to evaluate current practice with respect to diagnosis and treatment of hypophosphataemia in critically ill patients among intensive care unit (ICU) physicians in the Netherlands.
Methods: A survey was conducted among all hospitals
with an ICU in the Netherlands. Paediatric ICUs were
excluded from participation. A questionnaire was sent,
with questions on practice regarding serum phosphate
monitoring and treatment of hypophosphataemia. Respondents returned the questionnaire either by mail or
through a web-based survey. Results: A response was received from 67/89 ICUs (75%). Respondents mentioned renal replacement therapy, sepsis and malnutrition, as well as surgery involving cardiopulmonary bypass as the most important causes of
hypophosphataemia in intensive care unit patients. Of all
respondents, 46% reported to measure serum phosphate
levels on a daily basis, whereas in 12% serum phosphate levels were measured only on clinical indication. Less than half of the respondents had some sort of guideline for correction of hypophosphataemia. In a vast majority (79%), correction of hypophosphataemia was reported to start with serum
phosphate levels <0.60 mmol/l. Intravenous administration of phosphate was the preferred method of correction, with widely variable dosages and speeds of infusion. Complications of intravenous phosphate were reported to occur infrequently. Conclusion: There is large variability in the way serum phosphate is monitored and hypophosphataemia is treated in critically ill patients in the Netherlands.