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 Jan 2016
The thyroid gland was hypovascular, coarse,  hyperechoic, and had substantially decreased in mean total volume among Graves' hyperthyroidism patients following radioiodine therapy, based on a study
02 Jun 2017

Abnormal lung function and histological features have been found in diabetics, and there is enough evidence showing that the lungs are another target organ of diabetes, says a specialist at the 9th Diabetes Complications Conference and Grand Rounds organized by the National Diabetes Institute (NADI).

5 days ago
Global hypomethylation of Alu appears to increasingly influence distant metastatic differentiated thyroid cancer (DTC), poorly (P)DTC and anaplastic (A)TC, according to a recent study. This suggests that the epigenetic entity may be involved in thyroid cancer progression and dedifferentiation.
01 Nov 2015
Increased serum prolidase levels in Grave's disease patients without ophthalmopathy signs are positively associated with oxidative stress parameters as shown in a study.