hypophosphatemia%20-and-%20hyperphosphatemia
HYPOPHOSPHATEMIA & HYPERPHOSPHATEMIA
Treatment Guideline Chart

Hypophosphatemia is an electrolyte imbalance where there is a decrease in the serum phosphate level that is less than the normal range.

It is recognized most often in critically-ill patients, decompensated diabetics, alcoholics or other malnourished persons, and acute infectious or pulmonary disorders.

It may be transient and reflect intracellular shift with minimal clinical consequences.

Hyperphosphatemia is an electrolyte disturbance in which an increase in the serum phosphate level of more than the normal range is present.

Most symptoms of acute hyperphosphatemia are due to secondary hypocalcemia.

The significant level of hyperphosphatemia in adults is >6 mg/dL.

Hypophosphatemia & Hyperphosphatemia References

  1. DiMeglio LA, White KE, Econs MJ. Disorders of phosphate metabolism. Endocrinol Metab Clin North Am. 2000 Sep;29(3):591-609. PMID: 11033762
  2. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  3. Arnold JL, Bibb J. Hypophosphatemia. eMedicine. http://www.emedicine.com/. 2006.
  4. Berkoben M, Quarles LD. Management of hyperphosphatemia in chronic kidney disease. UpToDate. https://www.uptodate.com. Dec 2017. Accessed 12 Feb 2018.
  5. Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, ed. William's Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Inc; 2016. :1304-1307.
  6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD update work group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7:S1-S59. Accessed 12 Feb 2018
  7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD work group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009 Aug;113:S1-S59. doi: 10.1038/ki.2009.188. PMID: 19644521
  8. Moe SM, Kulkarni DP. Disorders of calcium, phosphorus and magnesium homeostasis. In: Gilbert SJ, Weiner DE, ed. National Kidney Foundation’s Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier Inc; 2018. :116.
  9. National Institute for Health and Clinical Excellence. Hyperphosphatemia in chronic kidney disease: management of hyperphosphatemia in patients with stage 4 or 5 chronic kidney disease. NICE. http://www.nice.org.co.uk. Mar 2013. Accessed 12 Feb 2018.
  10. Stubbs JR, Yu ASL. Overview of the causes and treatment of hyperphosphatemia. UpToDate. https://www.uptodate.com. Nov 2017. Accessed 12 Feb 2018.
  11. Voinescu A. Hyperphosphatemia. First consult. ClinicalKey. https://www.clinicalkey.com. Jan 2014. Accessed 12 Feb 2018.
  12. Yu ASL. Disorders of magnesium and phosphorus. In: Goldman L, Schaer AI . Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Inc; 2016. :776-778.
  13. Yu ASL, Stubbs JR. Evaluation and treatment of hypophosphatemia. UpToDate. https://www.uptodate.com. Jul 2017. Accessed 12 Feb 2018.
  14. Yu ASL, Stubbs JR. Signs and symptoms of hypophosphatemia. UpToDate. https://www.uptodate.com. Dec 2017. Accessed 12 Feb 2018.
  15. Ashby D, Borman N, Burton J, et al. Renal association clinical practice guideline on haemodialysis. BMC Nephrol. 2019 Oct;20(1):379. doi: 10.1186/s12882-019-1527-3. PMID: 31623578
  16. Berndt T, Kumar, R. Clinical disturbances of phosphate homeostasis. In: Alpern RJ, Moe OW, Caplan M. Seldin and Giebisch’s The Kidney: Physiology and Pathophysiology. 5th ed. UK: Elsevier; 2013. 2369-2391. Accessed 05 Mar 2021:2369-2391.
  17. Holden RM, Mustafa RA, Alexander RT, et al. Canadian Society of Nephrology commentary on the Kidney Disease Improving Global Outcomes 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder. Can J Kidney Health Dis. 2020 Aug;7:20543581-20944271. doi: 10.1177/2054358120944271. PMID: 32821415
  18. Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020 Sep;76(Suppl 1):S1-S107. doi: 10.1053/j.ajkd.2020.05.006. Accessed 03 Mar 2021. PMID: 32829751
  19. Rastogi A, Bhatt N, Rossetti S, et al. Management of hyperphosphatemia in end-stage renal disease: a new paradigm. J Ren Nutr. 2021 Jan;31(1):21-34. doi: 10.1053/j.jrn.2020.02.003. Accessed 04 Mar 2021. PMID: 32386937
  20. Imel EA, Econs MJ. Approach to the hypophosphatemic patient. J Clin Endocrinol Metab. 2012 Mar;97(3):696–706. doi: 10.1210/jc.2011-1319. PMID: 22392950
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