hypophosphatemia%20-and-%20hyperphosphatemia
HYPOPHOSPHATEMIA & HYPERPHOSPHATEMIA
Hypophosphatemia is recognized most often in critically-ill patients, decompensated diabetics, alcoholics or other malnourished persons, and acute infectious or pulmonary disorders.
A decrease in serum phosphate should be distinguished from a decrease in total body storage of phosphate.
Hypophosphatemia may be transient and reflect intracellular shift with minimal clinical consequences.
Most symptoms of acute hyperphosphatemia are due to secondary hypocalcemia.
The significant level of hyperphosphatemia in adults is 5 mg/dL.

Introduction

Hypophosphatemia is recognized most often in:
  • Critically-ill patients
  • Decompensated diabetics
  • Alcoholics or other malnourished persons
  • Acute infectious or pulmonary disorders

Hyperphosphatemia 

  • Significant level for hyperphosphatemia in adults: 5mg/dL (Normal range: 2.45-4.5 mg/dL (0.81-1.45 mmol/L)

Etiology

Hypophosphatemia 

  • More pronounced when there is underlying phosphate depletion (eg hyperparathyroidism,vitamin D deficiency, alcoholism & glycosuria)

Hyperphosphatemia

  • Decreased Renal Phosphate Excretion
    • Renal failure
    • Hypoparathyroidism
    • Pseudohypoparathyroidism
    • Tumoral calcinosis
    • Bisphosphonate therapy
    • Vitamin D intoxication
    • Acromegaly
    • Mg deficiency
  • Others
    • Acid-base disorders
    • Crush injuries
    • Fulminant hepatitis
    • Rhabdomyolysis
    • Artifactual due to hemolysis
    • Extracellular shift from intracellular compartment

Signs and Symptoms

Hypophosphatemia
Mild
  • Usually asymptomatic
Moderate-Severe
  • Confusion
  • Irritability
  • Apprehension
  • Fatigue
  • Myalgia & myopathy
  • Muscle weakness
  • Numbness
  • Paresthesia
  • Rhabdomyolysis
  • Seizures
  • Coma
  • Respiratory failure
  • Impairment of cardiac contractility
  • Cardiomyopathy
  • Hemolysis
  • Thrombocytopenia
  • Impaired phagocytosis
  • Metabolic encephalopathy
Hyperphosphatemia
Acute - Most symptoms are due to secondary hypocalcemia
  • Hypocalcemia
  • Neuromuscular irritability
  • Tetany

Chronic

  • Normocalcemia
  • Nephrocalcinosis
  • Soft tissue calcification
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
01 Jun 2015
Long-term oral testosterone undecanoate significantly improved IPSS quality of life scores in a 1-year, randomised, multicentre, double-blind trial among aging hypogonadal men.
Rachel Soon, 01 Jun 2016

The inclusion of statins in managing chronic kidney disease (CKD) may help reduce patient mortality from stroke and possibly other cardiovascular events, according to an expert at the 7th Malaysian Endocrine and Metabolic Society (MEMS) Annual Congress.

Rachel Soon, 01 Jun 2016

Patients with hypercholesterolaemia with unchanging LDL-cholesterol levels after 6 weeks of statin treatment should be actively assessed for either statin intolerance or resistance, says an expert at the 7th Malaysian Endocrine and Metabolic Society (MEMS) Annual Congress.

Prof. Cyrus Rustam Kumana, 07 Jul 2016

This case scenario was presented at a grand round in the Department of Medicine, The University of Hong Kong. Unlike traditional grand rounds that directly or indirectly deal with clinical challenges posed by patients, this one was equally about doctors and how they care for their charges. All doctors who tend patients dread being implicated on the receiving end of medico-legal proceedings. This topic is therefore intimately linked to the professionalism of doctors, their standing in the community, and the ethical aspects of how they interact with patients and relatives.