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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
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