From: Jerry Robinson Pharm.D.
To: David Collette
Cc: Pharmacists
Sent: Wednesday, August 16, 2017 9:11:34 AM
Subject: Re: Sodium phosphate IV shortage

As a followup to David's email concerning Phosphorus, there are a couple additional recommendations:

1. When entering order for phosphorus IVPB in ADULTS, infuse slower than current protocol. Recommend using 45 mmol over 8 hours, 30 mmol over 6 hours, 15 mmol over 4 hours. (This is being presented to P&T for approval based on ONLY 50% of current doses/infusions being therapeutic versus previous 70%).

2. If using POTASSIUM Phosphate, watch for additional Potassium CHLORIDE boluses . Patient likely will not need both POTASSIUM phosphate and potassium CHLORIDE.

45 mmol Potassium Phosphate = 66 mEq Potassium
30 mmol Potassium Phosphate = 44 mEq Potassium
15 mmol Potassium Phosphate = 22 mEq Potassium

3. If patient is able to tolerate NG or PO route, Neutra-Phos packets should be selected:

2 packets Neutra-Phos q 6 hr x 5 doses = 40 mmol absorbed phosphorus
2 packets Neutra-Phos q 6 hr x 4 doses = 32 mmol absorbed phosphorus
2 packets Neutra-Phos q 6 hr or q 8 hr x 3 doses = 24 mmol absorbed phosphorus
2 packets Neutra-Phos q 6 hr or q 8 hr x 2 doses = 16 mmol absorbed phosphorus

Let me know if you have additional questions.

Jerry Robinson, Pharm.D., BCPS
Clinical Specialist STICU/Co-Chairperson, Medication Safety Committee Department of Pharmacy Huntsville Hospital

From: David Collette
To: Pharmacists
Sent: Wednesday, August 16, 2017 8:33:35 AM
Subject: Sodium phosphate IV shortage

As most of you know, we are now facing a serious national shortage of IV sodium phosphate. In general, we are reserving our very small supply of IV sodium phosphate for the neonatal population.

I have had a couple of questions from pharmacists regarding our ability to substitute K Phos for Na Phos on the electrolyte protocol. As you know, there is already a statement on the protocol that allows us to use K Phos to treat hypophosphatemia in adults when appropriate and I feel that this covers us if we need to use K Phos during a severe shortage. To communicate this information to the medical staff, I have placed the following announcement on Pulse:

We are facing yet another serious drug shortage - IV sodium phosphate. Until this shortage resolves, we are reserving our small supply of IV sodium phosphate for our neonatal population. Please note that in adult patients in whom it is safe to do so, potassium phosphate IV may be used to treat hypophosphatemia. We will keep you updated on this and other serious drug shortages.

Until further notice, adult patients requiring IV phosphate repletion whose serum potassium is within the normal range should be bolused with POTASSIUM phosphate. If a patient has a CLINICALLY CRITICAL phosphate level and cannot tolerate the potassium salt, whether due to existing hyperkalemia or a combination of potassium level and renal dysfunction, you may consider using sodium phosphate in a very limited quantity.

Thank you for your compliance with these measures as we work to main our dwindling sodium phosphate supply for our neonatal population.

DAVID
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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services