Hypophosphataemia. Treatment of the underlying disorder and oral phosphate replacement are usually adequate in asymptomatic patients, even when the serum concentration is very low. Hypophosphatemia is an electrolyte disorder in which there is a low level of phosphate in the blood. Close monitoring is done, and more rapid rates of phosphate administration should be avoided to prevent hypocalcemia, hyperphosphatemia, and metastatic calcification due to excessive calcium phosphate product. Oral sodium phosphate or potassium phosphate may be poorly tolerated because of diarrhea. , MD, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham, (See also Overview of Disorders of Phosphate Concentration.). There are four major mechanisms by which hypophosphatemia can occur ( table 1 ): ● Redistribution of phosphate from the extracellular fluid into cells ● Decreased intestinal absorption of phosphate ● … 60-70% of ingested phosphate is hydrolyzed to an inorganic form that is absorbed actively and passively. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. Shajahan, A., Ajith Kumar, J., Gireesh Kumar, K. P., Sreekrishnan, T. P. and Jismy, K. (2015), Managing hypophosphatemia in critically ill patients: a report on an under-diagnosed electrolyte anomaly. However, a paradoxical consequence occurs; with muscle breakdown in rhabdomyolysis, the damaged cells release phosphate into the extracellular space, masking the clinical effects of hypophosphatemia. Disease severity can range from death in the perinatal period to dental problems or fractures i… Laboratory findings include low-normal serum calcium, moderately low serum phosphate, elevated serum alkaline phosphatase, and low serum 1,25 dihydroxy-vitamin D levels, hyperphosphaturia, and no evidence of hyperparathyroidism. Acute severe hypophosphatemia with serum phosphate < 1 mg/dL (< 0.32 mmol/L) is most often caused by transcellular shifts of phosphate often superimposed on chronic phosphate depletion. IV phosphate when serum phosphate is < 1 mg/dL (< 0.32 mmol/L) or symptoms are severe. The usual dose is 0.5 mmol phosphorus/kg (0.17 mL/kg) IV over 6 hours. Causes of low phosphate: Mechanisms can be multifactorial (and frequently is) in a given animal. Acute respiratory alkalosis and … Historically one of the first demonstrations of this was in people in concentration camp who died soon after being re-fed: it was observed that those given milk (high in phosphate) had a higher survival rate than those who did not get milk. Acute hypophosphatemia most often occurs in patients with of alcohol use disorder, burns, or starvation. Over 50% of the hospitalized alcoholics become hypophosphatemic when they are unable to eat for a period of days or develop an alcohol withdrawal state. Increased affinity for oxygen in the blood caused by decreased production of. It has been stated that 38% of hyperadrenocortical dogs have hypophosphatemia, but actual serum phosphorus concentrations were not reported. He was asymptomatic and not taking any drugs. Certain medicines, including insulin, acetazolamide, foscarnet, imatinib, intravenous iron, niacin, pentamidine, sorafenib, and tenofovir. [1] Symptoms may include weakness, trouble breathing, and loss of appetite. Spurious hypophosphatemia can be caused by interference of paraproteins or … Your body can also use it to produce energy and help your nerves function. Expand Section. Diagnosis is … Hypophosphatemia may be seen in association with hypocalcemia Hypocalcemia in eclampsia Puerperal tetany. Hypophosphatemia when combined with phosphate depletion can cause a variety of signs and symptoms. Although hypophosphatemia usually is asymptomatic, anorexia, muscle weakness, and osteomalacia can occur in severe chronic depletion. Hypophosphatemia is diagnosed by a serum phosphate concentration < 2.5 mg/dL (< 0.81 mmol/L). Hypophosphataemia. Purpose of review: Iron-induced hypophosphatemia is a well documented side-effect but associated complications are largely neglected, because the results from single dosing studies suggest that transient decreases in plasma phosphate concentrations are asymptomatic and fully reversible. [1] Complications may include seizures, coma, rhabdomyolysis, or softening of the bones. Chronic hypophosphatemia may be due to hormonal disorders (eg, hyperparathyroidism, Cushing syndrome, hypothyroidism), chronic diuretic use, or use of aluminum-containing antacids by patients with chronic kidney disease. (1b) Hungry Bone Syndrome Occurs immediately following resection of a parathyroid adenoma which was causing hyperparathyroidism. The following may cause hypophosphatemia… [1][3], Primary hypophosphatemia is the most common cause of non-nutritional rickets. Information. Causes of hypophosphatemia are shown in Table 1. Clinical features include muscle weakness, respiratory failure, and heart failure; seizures and coma can occur. Hypophosphatemia causes. Hypophosphatemia secondary to phosphorus redistribution is commonly caused by respiratory alkalosis and refeeding of malnourished patients. CAUSES. Pathophysiology. [5], Hypophosphatemia decreases 2,3-bisphosphoglycerate (2,3-BPG) causing a left shift in the oxyhemoglobin curve. The most common cause of hypophosphatemia is chronic alcoholism. Causes include the following: Increased parathyroid hormone levels, as in primary and secondary hyperparathyroidism, Other hormonal disturbances, such as Cushing syndrome and hypothyroidism, Electrolyte disorders, such as hypomagnesemia and hypokalemia, Severe chronic hypophosphatemia usually results from a prolonged negative phosphate balance. Learn more about our commitment to Global Medical Knowledge. Hypophosphatemia is caused by the following three mechanisms: Hypophosphatemia is diagnosed by measuring the concentration of phosphate in the blood. What are the signs and symptoms of hypophosphatemia? Causes include alcohol use disorder, burns, starvation, and diuretic use. This can be due to many causes but is quite common in malnourished individuals or excessive alcohol abusers who are given excessive amounts of carbohydrates resulting in increased demand for phosphorus by the body resulting in depleted levels of potassium. Toy, Girardet, Hormann, Lahoti, McNeese, Sanders, and Yetman. 4, 5 The manifestations are closely related to the severity and chronicity of its occurrence, with the plasma phosphate concentration usually being below 1.0 mg/dl (0.32 mmol/l) in symptomatic patients. Muscle dysfunction and weakness – This occurs in major muscles, but also may manifest as: Mental status changes – This may range from irritability to gross confusion, delirium, and coma. The most common cause is kidney disease, but other conditions can lead to phosphate levels being out of balance. Hypophosphatemia is a condition that describes low levels of phosphate in your blood. This can be seen in sick animals that are anorectic for prolonged periods but also in grazing animals in arid regions with low phosphorus content in soil. Symptoms may include weakness, trouble breathing, and loss of appetite. This page was last edited on 14 October 2020, at 19:00. The link you have selected will take you to a third-party website. Symptoms. Fanconi syndrome. Bone pain and fractures from weakened bones. Antacids. Testing to diagnose the cause is done when clinically indicated (eg, suggestive liver test results or signs of cirrhosis in patients with suspected alcohol use disorder). Certain blood cancers such as lymphoma or leukemia, Inadequate intake (often unmasked in refeeding after long-term low phosphate intake). Hypophosphatemia can occur when there are increased losses, decreased intake, or cellular shifts of phosphate. The muscle weakness of profound hypophosphatemia may be accompanied by rhabdomyolysis, especially in acute alcoholism. Journal of Clinical Pharmacy and Therapeutics. Hypophosphatemia also decreases neutrophil function and platelet survival. It should be administered in any of the following circumstances: When serum phosphate is < 1 mg/dL (< 0.32 mmol/L), Rhabdomyolysis, hemolysis, or central nervous system symptoms are present, Oral replacement is not feasible due to underlying disorder. [2], Treatment depends on the underlying cause. Shift of phosphorus from the extracellular to the intracellular space. Hypophosphatemia is an electrolyte disorder in which there is a low level of phosphate in the blood. Mild hypophosphatemia (ie, 2-2.5 mg/dL), whether acute or … Supplementation regimens are covered in electrolyte repletion. Phosphate can be given in doses up to about 1 g orally 3 times a day in tablets containing sodium phosphate or potassium phosphate. Artifact: Phosphate may be spuriously low if it precipitates out of solution. Causes of hypophosphatemia include: severe malnutrition, such as from anorexia or starvation alcoholism severe burns a diabetes complication called diabetic ketoacidosis the kidney disorder, Fanconi syndrome an excess of parathyroid hormone ( hyperparathyroidism) chronic diarrhea vitamin … doi: 10.1111/jcpt.12264, "Severe Hypophosphatemia in Respiratory Alkalosis", "Hypophosphatemia - Endocrine and Metabolic Disorders - Merck Manuals Professional Edition", https://en.wikipedia.org/w/index.php?title=Hypophosphatemia&oldid=983527157, Articles with unsourced statements from April 2019, Wikipedia articles needing clarification from October 2016, Articles with unsourced statements from September 2010, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License, Low blood phosphate, phosphate deficiency, hypophosphataemia, Weakness, trouble breathing, loss of appetite, Blood phosphate < 0.81 mmol/L (2.5 mg/dL). Please confirm that you are a health care professional. Causes include, Chronic starvation or malabsorption, often in patients with alcohol use disorder, especially when combined with vomiting or copious diarrhea, Long-term ingestion of large amounts of phosphate-binding aluminum, usually in the form of antacids. [6], Standard intravenous preparations of potassium phosphate are available and are routinely used in malnourished people and alcoholics. Cardiac monitoring is also advised. | Patient Hypophosphatemia can cause rhabdomyolysis via ATP depletion and the consequent inability of muscle cells to maintain membrane integrity. [1], Causes include alcoholism, refeeding in those with malnutrition, diabetic ketoacidosis, burns, hyperventilation, and certain medications. The severity of HPP can vary widely, from fetal death to fractures that don't begin until adulthood. In case of severe hypophosphatemia (< 1.5 mg/dL in cats), the following symptoms may be noted. Symptoms of hypophosphatemia are nonspecific and highly dependent on cause, duration, and severity. Last full review/revision Apr 2020| Content last modified Apr 2020, Hypophosphatemia is a serum phosphate concentration, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), Overview of Acid-Base Maps and Compensatory Mechanisms, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Musculoskeletal and Connective Tissue Disorders, Stomatocytosis and Anemia Caused by Hypophosphatemia. Concentrations of phosphate less than 0.81 mmol/L (2.5 mg/dL) are considered diagnostic of hypophosphatemia, though additional tests may be needed to identify the underlying cause of the disorder. [citation needed], Monitoring parameters during correction with IV phosphate[7]. One way to reduce your risk is by slowing kidney damage. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. A better knowledge of its causes, physiopathological effects and treatment should lead to a documented and homogenous care of these patients in clinics. Patients with advanced chronic kidney disease (especially those on dialysis) often take phosphate binders with meals to reduce absorption of dietary phosphate. If patients have impaired renal function or serum potassium > 4 mEq/L (> 4 mmol/L), sodium phosphate preparations generally should be used; these preparations also contain 3 mmol/mL of phosphorus and are thus given at the same dose. Acute severe hypophosphatemia can cause serious neuromuscular disturbances, rhabdomyolysis, seizures, coma, and death. Objective: The aim of our study was a systematic review of littérature, seeking for publications about causes, consequences and treatment of hypophosphatemia. Most causes of hypophosphatemia (eg, diabetic ketoacidosis, burns, refeeding) are readily apparent. Phosphorus levels should be monitored after 2 to 4 hours after each dose, also monitor serum potassium, calcium and magnesium. Hypophosphatemia is most commonly induced by one of three causes: (1) Inadequate phosphate intake, (2) increased phosphate excretion, and (3) shift from extracellular phosphate into the intracellular space 6). Finally, hypothermia leads to “low phosphate and potassium, high calcium and glucose, acidosis and azotemia,” notes Cornell University College of Veterinary Medicine. Hypophosphatemia is usually asymptomatic, but severe depletion can cause anorexia, muscle weakness, and osteomalacia. The prolonged use of these binders can cause hypophosphatemia, particularly when combined with greatly decreased dietary intake of phosphate. intake: malnutrition, phosphate binders, vitamin D, malabsorption, TPN; redistribution: refeeding syndrome, insulin in DKA; output: urinary – diuretics, osmotic diuresis, hyperparathyroidism, proximal tubular dysfunction (Fanconi’s syndrome) non-urinary –-> upper GI-> mid GI-> lower GI – diarrhoea Active transport is increased by the presence of calcitriol primarily in the presence of hypophosphatemia. The normal level for serum phosphate in neonates and children is considerably higher, up to 7 mg/dL for infants. Hypophosphatemia as a symptom: Conditions listing Hypophosphatemia as a symptom may also be potential underlying causes of Hypophosphatemia. Serum calcium and phosphate concentrations should be monitored during therapy, particularly when phosphate is given IV or to patients with impaired renal function. The trusted provider of medical information since 1899, Overview of Disorders of Potassium Concentration, Overview of Disorders of Calcium Concentration, Overview of Disorders of Magnesium Concentration, Overview of Disorders of Phosphate Concentration, Syndrome of Inappropriate ADH Secretion (SIADH). The Merck Manual was first published in 1899 as a service to the community. [citation needed]. Peter J. Tebben, M.D., of the Division of Endocrinology, Diabetes, Metabolism, and Nutrition and the Division of Pediatric Endocrinology and Metabolism in the Department of Pediatric and Adolescent Medicine at Mayo Clinic's campus in Rochester, Minnesota, says: "In general, the younger the age at diagnosis, the more severe the disease. [1] When levels are below 0.32 mmol/L (1.0 mg/dL) it is deemed to be severe. Hematologic disturbances of profound hypophosphatemia include hemolytic anemia, decreased release of oxygen from hemoglobin, and impaired leukocyte and platelet function. This site complies with the HONcode standard for trustworthy health information:   [1] Hypophosphatemia occurs in about 2% of people within hospital and 70% of people in the intensive care unit (ICU). However, severe hypophosphatemia can cause serious complications such as seizures, respiratory failure, and arrhythmias. Complications may include seizures, coma, rhabdomyolysis, or softening of the bones. One rare type of hypophosphatemia is passed down from parents to children. IV administration of potassium phosphate (as buffered mix of K2HPO4 and KH2PO4) is relatively safe when renal function is well preserved. This article discusses common and rare causes of hypophosphataemia, appropriate investigations, and when to refer for specialist opinion #### Learning points A 55 year old man with a squamous cell carcinoma of the head and neck was investigated before referral for chemotherapy. Treat the underlying disorder, but some patients require oral, or rarely, IV phosphate replacement. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Medications or substances causing Hypophosphatemia: You get phosphate from foods like milk, eggs and meat. Removal of the cause of hypophosphatemia may include stopping phosphate-binding antacids or diuretics or correcting hypomagnesemia. 125 In one study, an identifiable cause of hypophosphatemia could not be found in the majority of dogs with this serum biochemical abnormality. Hypophosphatasia (HPP) is a genetic condition that causes abnormal development of the bones and teeth. verify here. Hypophosphatemia is defined as a serum phosphate level of less than 2.5 mg/dL (0.8 mmol/L) in adults. Serious neuromuscular disturbances may occur, including progressive encephalopathy, seizures, coma, and death. [1] It is diagnosed based on a blood phosphate concentration of less than 0.81 mmol/L (2.5 mg/dL). [1] Phosphate may be given by mouth or by injection into a vein. Carcinoid syndrome sometimes develops in patients with carcinoid tumors. … The most common endocrine causes of hypophosphatemia are as follows: (1a) Hyperparathyroidism – as shown above, this may cause hypophosphatemia and hypercalcemia. Hyperphosphatemia is often a complication of chronic kidney disease. Low Blood Phosphate. Hypophosphatemia has numerous causes but clinically significant acute hypophosphatemia occurs in relatively few clinical settings, including the following: The recovery phase of diabetic ketoacidosis, When receiving total parenteral nutrition (TPN). The most common cause of chronic phosphorus deficiency is inadequate feed intake or inadequate phosphorus content in the diet over an extended time. Fat malabsorption in the gastrointestinal tract. Protect your kidneys … [1] It may also occur in the setting of hyperparathyroidism, hypothyroidism, and Cushing syndrome. HPP has been classified into five categories depending on the age at diagnosis. Lack of energy, or an energy drop. Supplementation by mouth is also useful where no intravenous treatment are available. Intravenous iron (usually for anemia) may cause hypophosphatemia. Confusion or seizures. In most cases, no more than 7 mg/kg (about 500 mg for a 70-kg adult) of phosphate should be given over 6 hours. Parenteral phosphate is usually given IV. The loss of phosphate is predominantly the result of renal wasting. Which of the following is a sign or symptom of carcinoid syndrome? Our database lists the following as having Hypophosphatemia as a symptom of that condition: Acid-Base Imbalance. Signs and symptoms may include poor feeding and respiratory problems in infancy; short stature; weak and soft bones; short limbs; other skeletal abnormalities; and hypercalcemia. The following may cause hypophosphatemia: Alcoholism. Blood test results showed phosphate 0.7 mmol/L … Hypophosphatemia is defined as a plasma phosphate level <2.5 mg/dl. Being irritable. Parenteral potassium phosphate contains 93 mg (3 mmol) phosphorus and 170 mg (4.4 mEq) potassium per mL. We do not control or have responsibility for the content of any third-party site. Hypophosphatemia occurs in 2% of hospitalized patients but is more prevalent in certain populations (eg, it occurs in up to 10% of hospitalized patients with alcohol use disorder). Too much phosphate in the blood is known as hyperphosphatemia. Chronic hypophosphatemia usually is the result of decreased renal phosphate reabsorption. True hypophosphatemia can be induced by decreased net intestinal absorption, increased urinary phosphate excretion, or acute movement of extracellular phosphate into the cells. Ingestion of 1 L of low-fat or skim milk provides 1 g of phosphate and may be more acceptable. 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2020 causes of hypophosphatemia