Since isolated phosphate deficiency is extremely unlikely, these patients invariably will have a comorbid reason for admission. Equilibration of IV with intracellular phosphate usually leads to recurrence of hypophosphatemia, making periodic monitoring and replacement necessary over the ensuing 2 days. A rational approach to IV phosphate replacement is to administer a predefined amount of phosphate, then reevaluate the resulting serum phosphate level every 6 hours to guide further treatment. Always administer IV phosphate cautiously in patients with renal failure. Medicine is a constantly changing science and not all therapies are clearly established.
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