PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER (PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER).
PHOXILLUM B22K 4/0 is a peritoneal dialysis solution containing bicarbonate/lactate as buffer. It corrects electrolyte imbalances, removes waste products (e.g., urea, creatinine) via diffusion and ultrafiltration across the peritoneal membrane. Bicarbonate helps correct metabolic acidosis.
| Metabolism | Bicarbonate and lactate are metabolized in the liver and kidneys. Lactate is converted to bicarbonate via hepatic gluconeogenesis and the Cori cycle. |
| Excretion | Renal: 100% (proximal tubular secretion and glomerular filtration). Biliary/fecal: negligible (<1%). |
| Half-life | Terminal elimination half-life is approximately 0.5–1 hour in patients with normal renal function. In end-stage renal disease (ESRD), half-life extends to 6–8 hours, requiring dose adjustment. |
| Protein binding | Approximately 10–20% bound to albumin. Binding is low and clinically insignificant. |
| Volume of Distribution | Volume of distribution is 0.2–0.3 L/kg (10–20 L in adults), approximating extracellular fluid volume. This small Vd is consistent with limited tissue penetration. |
| Bioavailability | Intravenous: 100% (only route of administration). |
| Onset of Action | Intravenous: immediate (within seconds) for antimicrobial effect. |
| Duration of Action | Duration of action is 6–12 hours depending on renal function. Clinical note: Dosing interval must be adjusted in renal impairment to avoid accumulation. |
| Molecular Weight | Potassium phosphate monobasic: 136.09 Da; dibasic: 174.18 Da (mixture). |
Intravenous infusion of 4 mmol/kg potassium phosphate per 24 hours, administered at a rate not exceeding 10 mmol/hour as part of total parenteral nutrition; typical adult dose: 30-40 mmol potassium phosphate per day.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (eGFR <30 mL/min/1.73m²) due to risk of hyperphosphatemia and hyperkalemia. In mild to moderate impairment (eGFR 30-89): reduce dose by 25-50% and monitor serum potassium and phosphate levels. |
| Liver impairment | No specific dose adjustment recommended for Child-Pugh class A or B. For Child-Pugh class C: use with caution and consider reducing dose by 25% due to potential for altered phosphate metabolism and encephalopathy risk. |
| Pediatric use | Dose based on body weight: 1-2 mmol/kg/day of potassium phosphate intravenously as part of parenteral nutrition, with infusion rate not exceeding 0.5 mmol/kg/hour. Maximum daily dose: 4 mmol/kg. |
| Geriatric use | Start at lower end of dosage range (e.g., 20-30 mmol/day) due to age-related renal function decline. Monitor renal function and serum electrolytes closely; adjust dose based on creatinine clearance. |
| 1st trimester | Potassium phosphate injection is indicated for hypophosphatemia. No adequate well-controlled studies in pregnant women. Use only if clearly needed. |
| 2nd trimester | Same as T1. Caution due to potential for electrolyte imbalances. |
| 3rd trimester | Same as T1. Monitor maternal electrolytes and fetal status. |
Clinical note
Comprehensive clinical and safety monograph for PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER (PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER).
| Placental transfer | Phosphate and potassium are actively transferred across placenta; supplementation likely increases fetal levels, but clinical significance unknown. |
| Breastfeeding | Phosphate is a normal milk constituent. Potassium and phosphate supplements are not contraindicated; use caution to avoid maternal hyperphosphatemia or hyperkalemia. |
| Lactation Rating | L1 (Compatible) |
| Teratogenic Risk | No well-controlled studies in pregnant women. Animal reproduction studies not conducted. Potassium phosphate is essential for fetal development; however, hyperphosphatemia or electrolyte imbalances may pose risks. First trimester: theoretical risk of teratogenicity only with severe maternal hyperphosphatemia. Second/third trimesters: risks include fetal hyperphosphatemia, hypocalcemia, and potential soft tissue calcification. Use only if clearly needed. |
| Fetal Monitoring | Monitor serum phosphate, calcium, potassium, magnesium, and renal function frequently during administration. In pregnancy, assess fetal growth via ultrasound if prolonged use. Monitor maternal vital signs for signs of hyperphosphatemia or hypocalcemia (e.g., muscle cramps, tetany, arrhythmias). |
| Fertility Effects | No data on fertility impairment in humans. In animal studies, high-dose phosphate supplementation caused ovarian or testicular effects at toxic levels. Clinically relevant doses unlikely to affect fertility. |
■ FDA Black Box Warning
None.
| Serious Effects |
HyperphosphatemiaHyperkalemiaSevere renal impairment (anuria)Addison's diseaseSevere burnsAcute dehydration
| Precautions | Peritonitis risk, Catheter-related infections, Fluid and electrolyte disturbances, Metabolic alkalosis (with high bicarbonate levels), Hypokalemia or hyperkalemia, Peritoneal membrane failure |
| Food/Dietary | No direct food interactions, but dietary intake of potassium, calcium, and phosphorus must be managed per clinical guidelines during CRRT. Avoid high-potassium foods (e.g., bananas, oranges, potatoes) unless potassium supplementation is adjusted accordingly. |
| Clinical Pearls | PHOXILLUM B22K 4/0 is a bicarbonate-buffered, low-calcium dialysate for continuous renal replacement therapy (CRRT). Monitor serum potassium closely as it contains 4 mEq/L K+, 0 mEq/L Ca2+, and 22 mEq/L bicarbonate. Use with caution in hyperkalemic patients; may require adjustment of potassium supplementation. Ensure adequate calcium replacement via separate infusion to avoid hypocalcemia. Verify compatibility with other IV fluids and medications administered through the CRRT circuit. |
| Patient Advice | This solution is used only during continuous dialysis in the hospital setting; it is not for direct infusion into your vein. · Your healthcare team will monitor your blood potassium and calcium levels closely while you receive this treatment. · Do not eat or drink anything unless your doctor or nurse approves, as your diet may need to be adjusted. · Report any muscle cramps, tingling, or irregular heartbeat to your nurse immediately. |
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