Phosphate salts

Phosphate salts refers to many different combinations of the chemical phosphate with salts and minerals.

Updated: July 1, 2019

Phosphate salts refers to many different combinations of the chemical phosphate with salts and minerals. Phosphates are normally absorbed from food and are important chemicals in the body. They are involved in cell structure, energy transport and storage, vitamin function, and numerous other processes essential to health. Phosphorus is a natural body mineral that is very important for building and maintaining bone. It helps control the amount of calcium in the body and urine. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Over time this can lead to increased risk of heart attack, stroke or death. Phosphorus and calcium control are very important for your overall health. Foods high in phosphate include dairy products, whole grain cereals, nuts, and certain meats. Phosphates found in dairy products and meats seem to be more easily absorbed by the body than phosphates found in cereal grains.
Phosphate salts are taken by mouth for treating blood phosphate levels that are too low and blood calcium levels that are too high, and for preventing kidney stones. They are also taken for treating osteomalacia (often called “rickets” in children), a condition caused by a mineral imbalance in the body that leads to softening of the bones. Phosphate salts are also used for improving exercise performance, as an antacid for gastroesophageal reflux disease (GERD), and as a laxative for emptying the bowels before surgery. Phosphate salts and calcium are applied to sensitive teeth to reduce pain. Phosphate salts are used as a laxative to clean the bowels before surgery or intestinal tests. Be careful not to confuse phosphate salts with substances such as organophosphates, or with tribasic sodium phosphates and tribasic potassium phosphates, which are very poisonous.

Dietary Sources:

Many people get all the phosphate they need from what they eat and drink.
Beverages like beer/ale, chocolate drinks, cocoa, dark colas, drinks made with milk, canned iced teas, pepper type soda (Dr Pepper), bottled beverages with phosphate additives are rich in Phosphate. These should be avoided as these can cause harm to your health. Lower phosphorus alternatives to enjoy: water, coffee, tea, rice milk (unenriched), apple juice, cranberry juice, grape juice, lemonade, ginger ale, lemon lime soda, orange soda, root beer.
Dairy Products such as cheese, custard, ice cream, milk, pudding and cream soups should be avoided. Lower phosphorus alternatives to enjoy: rice milk, almond milk, cottage cheese, vegan cheese, sherbet, popsicles.
Protein like oysters, sardines, beef liver, chicken liver, fish roe and organ meats should be avoided. Lower phosphorus alternatives to enjoy: chicken, turkey, fish, beef, veal, eggs, lamb, pork.
Chocolate candy, caramels, oat bran muffin, most processed/prepared foods/deli meats/hot dogs/bacon/sausage, pizza, brewer's yeast, chocolate, caramel candies should be avoided. Lower phosphorus alternatives to enjoy: apples, berries, grapes, carrot sticks, cucumber, rice cakes, unsalted pretzels, unsalted popcorn, unsalted crackers, pound cake, sugar cookies.

Phosphorus Deficiency:

Even when people don't get enough of this mineral in their diets, the body can compensate by reabsorbing what is already in the bloodstream. However, if you are deficient in other vitamins like vitamin D, you may also have more trouble absorbing phosphorus and other minerals, like calcium, because of how they work together.
Phosphorus deficiency can be caused by certain genetic disorders that affect the body's ability to store phosphorus. These disorders are often the result of excreting too much phosphorus in the urine or not absorbing the mineral from foods. It can also caused by starvation, alcoholism and diabetes.
Diabetes can also lead to a deficiency, especially for people recovering from an episode of diabetic ketoacidosis. This means that the body isn’t producing enough insulin and can’t break fat down as fuel. As a result, acids build up in the blood, which can cause a phosphorus deficiency. Individuals who are in treatment for eating disorders like anorexia may be on refeeding treatments. If these treatments are high in calories but too low in phosphorus, a deficiency may arise.
You may experience a number of bone-related symptoms if you have a phosphorus deficiency. For example, you may have bone pain or fragile bones that break more easily. Loss of appetite is another symptom that may make it difficult to boost your phosphorus levels through a healthy diet.
Other symptoms include:

  •     anxiety
  •     fatigue
  •     irregular breathing
  •     irritability
  •     joint stiffness
  •     numbness
  •     weakness
  •     changes in body weight

In addition, children who don't have enough phosphorus in their bodies may experience poor growth patterns or issues with bone and tooth development. Low phosphorus levels may lead to complications, especially if there is also a calcium imbalance. This can lead to Rickets and Osteomalacia. If the deficiency is severe enough, it may become life-threatening. If you are experiencing signs of deficiency, seek medical help.

Uses & Effectiveness:

Effective for:

Preparing the bowel for a medical procedure:

Sodium phosphate tablets (OsmoPrep, Visicol, Salix Pharmaceuticals, Raleigh, NC) can be used for cleansing the colon before a colonoscopy. Over-the-counter sodium phosphate solutions and enemas may also be used for bowel cleansing before medical procedures.

Low phosphate levels in the blood:

Taking sodium or potassium phosphate by mouth is effective for preventing or treating low phosphate levels in the blood. Intravenous phosphate salts may also treat low phosphate levels in the blood. However this should be used under the supervision of a physician.

Likely Effective for:   

Constipation:

Sodium phosphate is an FDA-permitted over-the-counter (OTC) that can be used for the treatment of constipation. These products are taken by mouth or used as enemas.

High calcium levels in the blood:

Taking phosphate salt (except calcium phosphate) by mouth is likely effective for treating high levels of calcium in the blood. But intravenous phosphate salts should not be used.

Indigestion:

Aluminum phosphate and calcium phosphate are FDA-permitted ingredients used in antacids.

Possibly Effective for:

Kidney stones (nephrolithiasis):

Taking potassium phosphate by mouth might help prevent calcium kidney stones from forming in patients with high urine levels of calcium.

Possibly InEffective for:

Athletic performance:

Taking sodium phosphate by mouth four times daily for 6 days might increase athletic performance in male cyclists. However, most evidence shows that taking phosphate salts by mouth does not improve exercise performance.

Insufficient Evidence for:

Diabetes complication (diabetic ketoacidosis):

Taking potassium phosphate intravenously (by IV) does not improve a diabetes complication in which the body produces too many blood acids called ketones. People with this condition should only be given phosphates if they have low phosphate levels.

Refeeding syndrome:

This is a complications that occur upon eating in people who were previously starving. Giving sodium and potassium phosphates intravenously (by IV) over 24 hours prevents refeeding syndrome when restarting nutrition in people who are severely malnourished or starved.
More evidence is needed to rate phosphate salts for the uses in case of Sensitive teeth and Other conditions.

Side Effects & Safety:

Phosphate salts containing sodium, potassium, aluminum, or calcium are likely safe for most people when taken by mouth short-term. It is condisderde as safe when sodium phosphate is inserted into the rectum appropriately for short-term, or when potassium phosphate is used intravenously (by IV) under the supervision of a physician.
Phosphate (expressed as phosphorus) is possibly unsafe when taken in amounts higher than 4 grams per day for adults younger than 70 years of age and 3 grams per day for people who are older. Regular long-term use can upset the balance of phosphates and other chemicals in the body and should be monitored by a healthcare professional to avoid serious side effects. Phosphate salts can irritate the digestive tract and cause stomach upset, diarrhea, constipation, and other problems. Do not take phosphate salts with substances such as organophosphates, or with tribasic sodium phosphates and tribasic potassium phosphates, which are very poisonous.

Special Precautions & Warnings:

Pregnancy and breast-feeding:

Phosphate salts from dietary sources are likely safe for pregnant or breast-feeding women when used at the recommended allowances of 1250 mg daily for mothers between 14-18 years of age and 700 mg daily for those over 18 years of age. Other doses are possibly unsafe and should only be used with the advice and ongoing care of a healthcare professional.

Children:

Phosphate salts are likely safe for children when used at the recommended daily allowances of

  • 460 mg for children 1-3 years of age
  • 500 mg for children 4-8 years of age 
  • 1250 mg for children 9-18 years of age.

Phosphate salts are possibly unsafe if the amount of phosphate consumed (expressed as phosphorous) exceeds the tolerable upper intake level (UL). The ULs are 3 grams per day for children 1-8 years; and 4 grams per day for children 9 years and older.

Fluid retention (edema):

Avoid using phosphate salts that contain sodium if you have cirrhosis, heart failure, or other conditions that can cause edema.

High levels of calcium in the blood (hypercalcemia):

Use phosphate salts cautiously if you have hypercalcemia. Too much phosphate could cause calcium to be deposited where it shouldn't be in your body.

Heart disease:

Avoid using phosphate salts that contain sodium if you have heart disease.

High levels of phosphate in the blood:

People with Addison's disease, severe heart and lung disease, kidney disease, thyroid problems, or liver disease are more likely than other people to develop too much phosphate in their blood when they take phosphate salts. Use phosphate salts only with the advice and ongoing care of a healthcare professional if you have one of these conditions.

Kidney disease:

Use phosphate salts only with the advice and ongoing care of a healthcare professional if you have kidney problems.

Interactions:

Be cautious with the below combination as this can have moderate interaction:

Bisphosphonates Interacts with phosphate salts:

Bisphosphonate medications and phosphate salts can both lower calcium levels in the body. Taking large amounts of phosphate salts along with bisphosphonate medications might cause calcium levels to become too low. Some bisphosphonates include alendronate (Fosamax), etidronate (Didronel), risedronate (Actonel), tiludronate (Skelid), and others.
Inform your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aspirin, digoxin, eplerenone, high blood pressure drugs (e.g., ACE inhibitors such as lisinopril, ARBs such as valsartan), potassium supplements/salt substitutes, vitamin products (e.g., vitamin D, calcium), certain "water pills" (e.g., potassium-sparing diuretics such as amiloride/spironolactone/triamterene).

Dosing:

The following doses have been studied in scientific research and is recommended:

Adults:

By Mouth:

For raising phosphate levels that are too low or lowering calcium levels that are too high:

Healthcare providers measure the levels of phosphate and calcium in the blood and give just enough phosphate to correct the problem.
As a supplement, the recommended daily dietary allowances (RDAs) of phosphate (expressed as phosphorus) are:

  • Children 1-3 years, 460 mg
  • children 4-8 years, 500 mg
  • men and women 9-18 years, 1250 mg
  • men and women over 18 years, 700 mg.

The adequate intakes (AI) for infants are:

100 mg for infants 0-6 months old and 275 mg for infants 7-12 months of age.
Tolerable Upper Intake Levels (UL), the highest intake level at which no unwanted side effects are expected, for phosphate (expressed as phosphorus) per day are:

  • children 1-8 years, 3 grams per day
  • children and adults 9-70 years, 4 grams
  • adults older than 70 years, 3 grams
  • pregnant women 14-50 years, 3.5 grams 
  • breast-feeding women 14-50 years, 4 grams.

There are many different kinds of phosphate binders. Pills, chewable tablets, powders, and liquids are available. Some types also contain calcium, while others do not. Supplements should only be taken under medical supervision, as a surplus of phosphorus can also have health implications. How much you take will be determined by your doctor. Take this medication 2-3 hours before or after taking any products containing magnesium, aluminum, or calcium. Some examples include quinapril, didanosine, vitamins/minerals, and antacids. Dairy products (e.g., milk, yogurt), calcium-enriched juice, sucralfate, bismuth subsalicylate, iron, and zinc are also included. These products bind with phosphate, preventing its full absorption.


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