PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER (PHOXILLUM B22K 4/0 IN PLASTIC CONTAINER).
| Breastfeeding | Potassium phosphate is present in human milk at levels consistent with physiological requirements. Milk-to-plasma ratio not established. Exogenous phosphate is rapidly absorbed and may cause hyperphosphatemia in the infant at high maternal doses. Caution advised; monitor infant for signs of hyperphosphatemia (e.g., hypocalcemia, tetany). |
| 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. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to any component","Pre-existing severe metabolic alkalosis","Documented peritoneal membrane failure","Abdominal or peritoneal defects (e.g., hernias, fistulas)","Uncorrected mechanical defects in peritoneal cavity"]
| Precautions | ["Peritonitis risk","Catheter-related infections","Fluid and electrolyte disturbances","Metabolic alkalosis (with high bicarbonate levels)","Hypokalemia or hyperkalemia","Peritoneal membrane failure"] |
Loading safety data…
| 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. |