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.

Hypophosphatemia%20-and-%20hyperphosphatemia Signs and Symptoms


Hypophosphatemia is recognized most often in:
  • Critically ill patients or sepsis
  • Decompensated diabetics
  • Alcoholics or other malnourished persons
  • Acute infectious or pulmonary disorders
  • Patients who are on IV hyperalimentation without phosphate supplementation
  • Patients with urinary phosphate-wasting syndromes (eg Fanconi syndrome or tumor-induced osteomalacia)


  • Defined as an electrolyte disturbance in which an increase in the serum phosphate level of more than the normal range is present



  • More pronounced when there is underlying phosphate depletion (eg hyperparathyroidism, vitamin D deficiency, alcoholism and glycosuria)
  • Mechanisms that may cause hypophosphatemia:
    • Increased urinary losses due to impaired intestinal absorption
    • Redistribution of phosphate from extracellular fluid into the intracellular space or the mineral phase of bone
    • Removal by renal replacement therapies
    • Severe and selective deprivation of dietary phosphate that rarely occurs


  • Decreased Renal Phosphate Excretion
    • Renal failure
    • Hypoparathyroidism
    • Pseudohypoparathyroidism
    • Familial tumoral calcinosis
    • Bisphosphonate therapy
    • Vitamin D intoxication
    • Acromegaly
    • Magnesium deficiency
    • Fibroblast growth factor inhibitors (eg Erdafitinib)
  • Others
    • Acid-base disorders
    • Crush injuries
    • Fulminant hepatitis
    • Rhabdomyolysis
    • Artifactual due to hemolysis
    • Extracellular shift from intracellular compartment
    • Chronic Heparin therapy

Signs and Symptoms



  • Usually asymptomatic


  • Neurological: Confusion, irritability, apprehension, fatigue, numbness, paresthesia, seizures, coma, metabolic encephalopathy
  • Musculoskeletal: Myalgia and myopathy, muscle weakness, rhabdomyolysis, rickets, osteomalacia
  • Respiratory: Reversible respiratory failure
  • Cardiovascular: Impairment of cardiac contractility, cardiomyopathy
  • Hematological: Hemolysis, thrombocytopenia, impaired phagocytosis


Acute - Most symptoms are due to secondary hypocalcemia 

  • Hypocalcemia
  • Neuromuscular irritability/muscle cramps
  • Tetany
  • Paresthesias
  • Seizures
  • Hypotension
  • Cardiac arrhythmia

Chronic - Persistent hyperphosphatemia (>12 hours) that usually occurs in patients with chronic renal failure and familial tumoral calcinosis

  • Normocalcemia
  • Nephrocalcinosis
  • Soft tissue or vascular calcification
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