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Hypophosphatemia

Last updated: June 17, 2020

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Hypophosphatemia is defined as a serum phosphate of < 2.5 mg/dL. It is more common in patients with alcohol use disorder and in critically unwell patients, who have high phosphate demands. Particularly in mild deficiency, symptoms can be nonspecific or absent entirely. However, severe hypophosphatemia can cause serious complications such as seizures, respiratory failure, and arrhythmias. Treatment may be oral or intravenous, depending on the severity of the deficiency, and should occur in conjunction with investigation of underlying causes. Supplementation regimens are covered in electrolyte repletion.

  • Serum phosphate of < 2.5 mg/dL [1]
  • Severe hypophopshatemia occurs at < 1 mg/dL. [1]

Mechanism

Cause [2][3][4]

Increased renal excretion

Insufficient intestinal absorption

Transcellular phosphate shifts

Extreme catabolic states

Pseudohypophosphatemia

Although mild hypophosphatemia rarely causes symptoms, moderate to severe hypophosphatemia is associated with various cardiac, musculoskeletal, neurological, and hematological abnormalities. [3][4]

We list the most important complications. The selection is not exhaustive.

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  4. Rejai S, Singh SP. Textbook of Critical Care, 7th edition E-Book. Elsevier Health Sciences ; 2016 : p. 56-57
  5. Dadoniene J, Miglinas M, Miltiniene D, et al. Tumour-induced osteomalacia: a literature review and a case report. World J Surg Oncol. 2015; 14 (1). doi: 10.1186/s12957-015-0763-7 . | Open in Read by QxMD
  6. Wrighton LJ, O'Bosky KR, Namm JP, Senthil M. Postoperative management after hepatic resection.. J Gastrointest Oncol. 2012; 3 (1): p.41-7. doi: 10.3978/j.issn.2078-6891.2012.003 . | Open in Read by QxMD
  7. Demirjian S, Teo BW, Guzman JA, et al. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant. 2011; 26 (11): p.3508-3514. doi: 10.1093/ndt/gfr075 . | Open in Read by QxMD
  8. Suki WN, Massry SG. Therapy of Renal Diseases and Related Disorders. Springer Science & Business Media ; 2012
  9. Liamis G, Milionis HJ, Elisaf M. Medication-induced hypophosphatemia: a review. QJM. 2010; 103 (7): p.449-459. doi: 10.1093/qjmed/hcq039 . | Open in Read by QxMD
  10. Srivastava R, Bagga A. Pediatric Nephrology. JP Medical Ltd ; 2016
  11. Lervang H-H, Ditzel J. Disturbance of inorganic phosphate metabolism in diabetes mellitus: clinical manifestations of phosphorus-depletion syndrome during recovery from diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2010 : p.319. doi: 10.2147/dmsott.s13476 . | Open in Read by QxMD
  12. Suarez N, Conway N, Pickett T. Panic-related hyperventilation resulting in hypophosphataemia and a high lactate. BMJ Case Rep. 2013; 2013 (may09 1): p.bcr2013009307-bcr2013009307. doi: 10.1136/bcr-2013-009307 . | Open in Read by QxMD
  13. Hypophosphatemia. https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypophosphatemia. Updated: March 1, 2018. Accessed: January 2, 2020.