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.

Principles of Therapy

Hypophosphatemia:
  • Presence of signs & symptoms suggestive of phosphate deficiency
    • Most important consideration 
  • Estimated severity of cellular phosphate deficit
  • Overall clinical status of the patient
  • Renal insufficiency, simultaneous administration of intravenous (IV) glucose or hyperalimentation solutions
  • Risk of aggravating coexistent hypocalcemia
Hyperphosphatemia
  • Resolve underlying cause
  • Resolution of symptoms
  • Serum Ca level w/in the low reference range

Pharmacotherapy

Hypophosphatemia

Phosphate intravenous (IV)

  • In patients w/o severe renal insufficiency or hypocalcemia, IV phosphate at a rate of 2-8 mmol/hour of elementalphosphorous over 4-8 hours often corrects hypophosphatemia w/o inducing hyperphosphatemia or hypocalcemia
  • Monitor serum Ca & phosphate every 6-12 hours during & after phosphate therapy
  • Recurrent hypophosphatemia w/in 24-48 hours of apparently successful replacement may require additional infusions

Hyperphosphatemia

Oral binders

  • Administered to decrease gastrointestinal (GI) absorption of phosphorous
  • Ca-containing phosphate binders may increase Ca-phosphate product & induce vascular calcium deposition
  • Resin binders promote excretion of phosphorous w/o affecting Ca
  • Avoid aluminum-containing phosphate binders in patients w/ renal failure

Diuretics

  • Those that act on the proximal tubules (eg Acetazolamide) may be considered to promote renal phosphate excretion

Non-Pharmacological Therapy

Hypophosphatemia

  • In most asymptomatic patients, serum phosphate level spontaneously normalizes w/in several days when factors that trigger hypophosphatemia are corrected
  • Dairy products supply absorbable Ca that help avoid hypocalcemia that may result from more aggressive replacement therapies

Hyperphosphatemia

Dialysis

  • Hemodialysis or peritoneal dialysis is indicated for severe refractory cases & for patients w/ renal failure

Gastric lavage

  • May be performed in toxic ingestions
  • Oral phosphate binders are given to prevent further absorption
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
Jairia Dela Cruz, 23 Sep 2017
Laparoscopic sleeve gastrectomy (SG) appears to be effective in Asians, with early weight loss correlating with midterm weight maintenance and remission of obesity-related comorbidities 1 year after the surgery, according to a study.
Audrey Abella, 26 Sep 2017
The novel, G-protein coupled receptor 119 (GPR119) agonist DS-8500a demonstrated dose-dependent glucose-lowering effects and favourable improvements in lipid parameters that extended up to 12 weeks in Japanese patients with type 2 diabetes mellitus (T2D), according to data presented at EASD 2017.
Pearl Toh, 23 Sep 2017
The incidence of cardiovascular (CV) events at 5 years was similar when adding sulphonylureas or pioglitazone to metformin in patients with type 2 diabetes (T2D) inadequately controlled with metformin alone, according to a head-to-head comparison in the TOSCA.IT* trial.
Kavitha G. Shekar, 21 Jun 2016

The American Diabetes Association’s (ADA) President Desmond Schatz challenged the scientific community to transform diabetes from an invisible disease to a highly visible crisis. “Diabetes is an epidemic spiralling out of control across this country and around the world, yet it remains largely invisible,” he said, speaking at the 76th Scientific Sessions of ADA in New Orleans, Louisiana, US.