Mild Symptomatic Hyperphosphatemia 2 mgdL greater than ageadjusted norm

1. Dietary restriction. Limit phosphorus intake to 800-1000 mg/day by avoiding milk and other foods high in phosphate (obtain dietary consultation). In infants, low-phosphate formulas (Similac Pm 60/40) or breast milk are useful in lowering phosphorus levels.

2. Phosphate binders. Oral phosphate-binding agents are useful in blocking absorption of phosphate in food and intestinal fluids. Clinician can choose from magnesium- or aluminum-containing phosphate binders (avoid in chronic renal failure), calcium agents such as calcium carbonate or calcium acetate (avoid with hypercalcemia), and calcium-free phosphate binder (Sevelamer). These binders are best administered with meals; if patient is NPO, give at regular intervals around the clock to bind phosphorus in GI secretions.

3. Renal excretion. In patients with tumor lysis syndrome and other acute release of phosphorus from cells, maintain diuresis and renal function with aggressive hydration.

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