Phosphate in Acute Pancreatitis

Purpose

The goal of this study is to learn if phosphate administration works to treat acute pancreatitis in adults presenting to the emergency department at Duke University Hospital. The main questions it aims to answer are: - Does having low phosphate levels increase the risk of acute pancreatitis and can giving phosphate through an IV make the illness less severe? - Is phosphate therapy practical to use, and what is the appropriate dose? - Is this study achievable, and how can the results help design a future randomized controlled trial to assess safety and effectiveness? Participants will: - Receive standard of care or intravenous (IV) phosphate during their hospital stay - Have blood samples collected during admission to monitor phosphorus levels - Complete follow-up assessments after hospital admission to evaluate how severe the illness is and the effects of phosphate supplementation

Condition

  • Pancreatitis

Eligibility

Eligible Ages
Over 18 Years
Eligible Sex
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Age 18 years or older - Presenting to the emergency department (ED) with acute pancreatitis meeting 2 or more characteristics of: (1) typical, persistent, severe upper abdominal pain, (2) lipase or amylase levels at least three times greater than the upper limit of normal, and/or (3) characteristic findings on abdominal imaging) - Trial treatment can be initiated within 24 hours of hospital admission - Consent can be obtained from the patient or their legal representative

Exclusion Criteria

Contraindications to injectable phosphate including: - Hyperkalemia - Hypercalcemia or significant hypocalcemia - Severe renal impairment (eGFR <30 mL/min/1.73m2) or end-stage renal disease

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Non-Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
No Intervention
Standard of Care Observational Phase 		During the first year of enrollment, 50 control group participants will be enrolled in an observational phase and receive usual care only with fluid resuscitation at the discretion of the clinical team. Serum phosphorus levels will be checked every 6 hours and additional blood samples will be collected daily to monitor patients' lab values during their hospital stay.
Experimental
Phosphate Treatment Phase 		During the second year of enrollment, 50 treatment group participants will be enrolled and receive usual care plus continuous sodium phosphate or potassium phosphate (in the case of hypernatremia) which will be delivered by continuous peripheral intravenous infusion at a rate of 30 mmol every 6 hours, as long as serum phosphorus levels are ≤ 4.0 mg/dL. Phosphate infusion will be initiated as soon as possible after patient enrollment and continued for a maximum duration of 72 hours or until patient discharge from the hospital, whichever occurs sooner. Serum phosphorus levels will be checked every 6 hours, and the infusion will be paused until the next recheck if the level rises >4.0 mg/dL. Additional blood samples will be collected daily to monitor patients' lab values during their hospital stay.
  • Drug: Sodium Phosphate
    The treatment is administered via continuous peripheral intravenous infusion at a rate of 30 mmol every 6 hours, provided serum phosphorus levels remain at or below 4.0 mg/dL; it begins upon patient enrollment and continues for up to 72 hours.
    Other names:
    • Sodium Phosphate Injection, USP, 3mM P/mL
  • Drug: Potassium Phosphate
    This treatment will be used in case of hypernatremia. The treatment is administered via continuous peripheral intravenous infusion at a rate of 30 mmol every 6 hours, provided serum phosphorus levels remain at or below 4.0 mg/dL; it begins upon patient enrollment and continues for up to 72 hours.
    Other names:
    • Potassium Phosphates Injection

Recruiting Locations

Duke University Medical Center
Durham, North Carolina 27710
Contact:
Lezly Collins
lezly.collins@duke.edu

More Details

Status
Recruiting
Sponsor
Duke University

Study Contact

Samuel Francis, MD
919-684-5537
samuel.francis@duke.edu

Detailed Description

This prospective, two-phase pilot clinical trial will enroll 100 adult emergency department patients with acute pancreatitis (50 per phase) at Duke University Hospital. Phase one will consist of an observational control group receiving usual care, with serum phosphorus collected throughout the emergency department visit and hospitalization to examine how phosphorus levels change over time and relate to disease severity and clinical outcomes. Phase two will include a treatment group receiving continuous intravenous sodium phosphate or potassium phosphate infusions to maintain high-normal serum phosphorus levels (4.0-4.5 mg/dL) during the first 72 hours of hospitalization. Phosphate dosing requirements will be determined and compared across varying levels of disease severity to assess whether more severe illness is associated with greater supplementation needs. Overall, the study will characterize phosphorus dynamics in acute pancreatitis, evaluate the feasibility and dosing of phosphate repletion, and generate preliminary data to inform the design of a future randomized controlled trial assessing the safety and efficacy of phosphate therapy.