Figure 1819

Electrolytes in acute renal failure (ARF): hypophosphatemia and hypokalemia. It must be noted that a considerable number of patients with ARF do not present with hyperkalemia or hyperphos-phatemia, but at least 5% have low serum potassium and more than 12% have decreased plasma phosphate on admission [38]. Nutritional support, especially parenteral nutrition with low electrolyte content, can cause hypophosphatemia and hypokalemia in as many as 50% and 19% of patients respectively [39,40].

In the case of phosphate, phosphate-free artificial nutrition causes hypophosphatemia within a few days, even if the patient was hyper-phosphatemic on admission (black circles) [41]. Supplementation of 5 mmol per day was effective in maintaining normal plasma phosphate concentrations (open squares), whereas infusion of more than 10 mmol per day resulted in hyperphosphatemia, even if the patients had decreased phosphate levels on admission (open circles).

Potassium or phosphate depletion increases the risk of developing ARF and retards recovery of renal function. With modern nutritional support, hyperkalemia is the leading indication for initiation of extracorporeal therapy in fewer than 5% of patients [38]. (Adapted from Kleinberger et al. [41]; with permission.)

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