Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1984 Jan 1;130(1):17–23.

A clinical approach to common electrolyte problems: 3. Hypophosphatemia.

C Berkelhammer, R A Bear
PMCID: PMC1875686  PMID: 6418367

Abstract

Hypophosphatemia is a common disorder caused by decreased intake, increased loss or transcellular shift of phosphorus. Symptoms of severe hypophosphatemia include reversible depression of myocardial function, acute respiratory failure, coma, rhabdomyolysis, osteomalacia, renal tubular acidosis and hemolysis. This paper discusses common clinical disorders associated with hypophosphatemia and presents an approach to diagnosis and treatment.

Full text

PDF
17

Images in this article

17p17-a
on p.17

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agus Z. S. Oncogenic hypophosphatemic osteomalacia. Kidney Int. 1983 Jul;24(1):113–123. doi: 10.1038/ki.1983.133. [DOI] [PubMed] [Google Scholar]
  2. Ahmed K. Y., Varghese Z., Wills M. R., Meinhard E., Skinner R. K., Baillod R. A., Moorhead J. F. Persistent hypophosphataemia and osteomalacia in dialysis patients not on oral phosphate-binders: Response to dihydrotachysterol therapy. Lancet. 1976 Aug 28;2(7983):439–442. doi: 10.1016/s0140-6736(76)92526-5. [DOI] [PubMed] [Google Scholar]
  3. Betro M. G., Pain R. W. Hypophosphataemia and hyperphosphataemia in a hospital population. Br Med J. 1972 Jan 29;1(5795):273–276. doi: 10.1136/bmj.1.5795.273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boelens P. A., Norwood W., Kjellstrand C., Brown D. M. Hypophosphatemia with muscle weakness due to antacids and hemodialysis. Am J Dis Child. 1970 Oct;120(4):350–353. doi: 10.1001/archpedi.1970.02100090124016. [DOI] [PubMed] [Google Scholar]
  5. Colman P., Firkin B. G., van der Weyden M. B. Severe hypophosphataemia in T-cell lymphoblastic lymphoma. Br Med J (Clin Res Ed) 1983 Jan 8;286(6359):105–106. doi: 10.1136/bmj.286.6359.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Craddock P. R., Yawata Y., VanSanten L., Gilberstadt S., Silvis S., Jacob H. S. Acquired phagocyte dysfunction. A complication of the hypophosphatemia of parenteral hyperalimentation. N Engl J Med. 1974 Jun 20;290(25):1403–1407. doi: 10.1056/NEJM197406202902504. [DOI] [PubMed] [Google Scholar]
  7. Davis G. R., Zerwekh J. E., Parker T. F., Krejs G. J., Pak C. Y., Fordtran J. S. Absorption of phosphate in the jejunum of patients with chronic renal failure before and after correction of vitamin D deficiency. Gastroenterology. 1983 Oct;85(4):908–916. [PubMed] [Google Scholar]
  8. DeFronzo R. A., Lang R. Hypophosphatemia and glucose intolerance: evidence for tissue insensitivity to insulin. N Engl J Med. 1980 Nov 27;303(22):1259–1263. doi: 10.1056/NEJM198011273032203. [DOI] [PubMed] [Google Scholar]
  9. Emmett M., Seldin D. W. Disturbances in acid-base balance during hypophosphatemia and phosphate depletion. Adv Exp Med Biol. 1978;103:313–325. doi: 10.1007/978-1-4684-7758-0_33. [DOI] [PubMed] [Google Scholar]
  10. Farrington K., Varghese Z., Newman S. P., Ahmed K. Y., Fernando O. N., Moorhead J. F. Dissociation of absorptions of calcium and phosphate after successful cadaveric renal transplantation. Br Med J. 1979 Mar 17;1(6165):712–714. doi: 10.1136/bmj.1.6165.712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fitzgerald F. Clinical hypophosphatemia. Annu Rev Med. 1978;29:177–189. doi: 10.1146/annurev.me.29.020178.001141. [DOI] [PubMed] [Google Scholar]
  12. Fuller T. J., Nichols W. W., Brenner B. J., Peterson J. C. Reversible depression in myocardial performance in dogs with experimental phosphorus deficiency. J Clin Invest. 1978 Dec;62(6):1194–1200. doi: 10.1172/JCI109239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gertner J. M., Lilburn M., Domenech M. 25-Hydroxycholecalciferol absorption in steatorrhoea and postgastrectomy osteomalacia. Br Med J. 1977 May 21;1(6072):1310–1312. doi: 10.1136/bmj.1.6072.1310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Guthrie G. P., Jr, Curtis J. J., Beilman K. M. Hypophosphatemia in thyrotoxic periodic paralysis. Arch Intern Med. 1978 Aug;138(8):1284–1285. [PubMed] [Google Scholar]
  15. Hoikka V., Alhava E. M., Savolainen K., Karjalainen P., Parviainen M. The effect of partial gastrectomy on bone mineral metabolism. Scand J Gastroenterol. 1982 Mar;17(2):257–261. doi: 10.3109/00365528209182049. [DOI] [PubMed] [Google Scholar]
  16. Jacob H. S., Amsden T. Acute hemolytic anemia with rigid red cells in hypophosphatemia. N Engl J Med. 1971 Dec 23;285(26):1446–1450. doi: 10.1056/NEJM197112232852602. [DOI] [PubMed] [Google Scholar]
  17. Janson C., Birnbaum G., Baker F. J., 2nd Hypophosphatemia. Ann Emerg Med. 1983 Feb;12(2):107–116. doi: 10.1016/s0196-0644(83)80387-4. [DOI] [PubMed] [Google Scholar]
  18. Juan D., Elrazak M. A. Hypophosphatemia in hospitalized patients. JAMA. 1979 Jul 13;242(2):163–164. [PubMed] [Google Scholar]
  19. Keller U., Berger W. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetes. 1980 Feb;29(2):87–95. doi: 10.2337/diab.29.2.87. [DOI] [PubMed] [Google Scholar]
  20. Knochel J. P., Barcenas C., Cotton J. R., Fuller T. J., Haller R., Carter N. W. Hypophosphatemia and rhabdomyolysis. J Clin Invest. 1978 Dec;62(6):1240–1246. doi: 10.1172/JCI109244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Knochel J. P. Neuromuscular manifestations of electrolyte disorders. Am J Med. 1982 Mar;72(3):521–535. doi: 10.1016/0002-9343(82)90522-8. [DOI] [PubMed] [Google Scholar]
  22. Knochel J. P. The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med. 1977 Feb;137(2):203–220. [PubMed] [Google Scholar]
  23. Kreisberg R. A. Diabetic ketoacidosis: new concepts and trends in pathogenesis and treatment. Ann Intern Med. 1978 May;88(5):681–695. doi: 10.7326/0003-4819-88-5-681. [DOI] [PubMed] [Google Scholar]
  24. Lee J. L., Sibbald W. J., Holliday R. L., Linton A. L. Hypophosphatemia associated with coma. Can Med Assoc J. 1978 Jul 22;119(2):143–145. [PMC free article] [PubMed] [Google Scholar]
  25. Lentz R. D., Brown D. M., Kjellstrand C. M. Treatment of severe hypophosphatemia. Ann Intern Med. 1978 Dec;89(6):941–944. doi: 10.7326/0003-4819-89-6-941. [DOI] [PubMed] [Google Scholar]
  26. Levy L. A. Severe hypophosphatemia as a complication of the treatment of hypothermia. Arch Intern Med. 1980 Jan;140(1):128–129. [PubMed] [Google Scholar]
  27. Lichtman M. A., Miller D. R., Cohen J., Waterhouse C. Reduced red cell glycolysis, 2, 3-diphosphoglycerate and adenosine triphosphate concentration, and increased hemoglobin-oxygen affinity caused by hypophosphatemia. Ann Intern Med. 1971 Apr;74(4):562–568. doi: 10.7326/0003-4819-74-4-562. [DOI] [PubMed] [Google Scholar]
  28. Lotz M., Zisman E., Bartter F. C. Evidence for a phosphorus-depletion syndrome in man. N Engl J Med. 1968 Feb 22;278(8):409–415. doi: 10.1056/NEJM196802222780802. [DOI] [PubMed] [Google Scholar]
  29. Massry S. G. The clinical syndrome of phosphate depletion. Adv Exp Med Biol. 1978;103:301–312. doi: 10.1007/978-1-4684-7758-0_32. [DOI] [PubMed] [Google Scholar]
  30. Matzner Y., Prococimer M., Polliack A., Rubinger D., Popovtzer M. M. Hypophosphatemia in a patient with lymphoma in leukemic phase. Arch Intern Med. 1981 May;141(6):805–806. [PubMed] [Google Scholar]
  31. Moorhead J. F., Wills M. R., Ahmed K. Y., Baillod R. A., Varghese Z., Tatler G. L. Hypophosphataemic osteomalacia after cadaveric renal transplantation. Lancet. 1974 Apr 20;1(7860):694–697. doi: 10.1016/s0140-6736(74)92902-x. [DOI] [PubMed] [Google Scholar]
  32. Moser C. R., Fessel W. J. Rheumatic manifestations of hypophosphatemia. Arch Intern Med. 1974 Oct;134(4):674–678. [PubMed] [Google Scholar]
  33. Narins R. G., Jones E. R., Stom M. C., Rudnick M. R., Bastl C. P. Diagnostic strategies in disorders of fluid, electrolyte and acid-base homeostasis. Am J Med. 1982 Mar;72(3):496–520. doi: 10.1016/0002-9343(82)90521-6. [DOI] [PubMed] [Google Scholar]
  34. Newman J. H., Neff T. A., Ziporin P. Acute respiratory failure associated with hypophosphatemia. N Engl J Med. 1977 May 12;296(19):1101–1103. doi: 10.1056/NEJM197705122961908. [DOI] [PubMed] [Google Scholar]
  35. O'Connor L. R., Wheeler W. S., Bethune J. E. Effect of hypophosphatemia on myocardial performance in man. N Engl J Med. 1977 Oct 27;297(17):901–903. doi: 10.1056/NEJM197710272971702. [DOI] [PubMed] [Google Scholar]
  36. Prins J. G., Schrijver H., Staghouwer J. H. Hyperalimentation, hypophosphataemia, and coma. Lancet. 1973 Jun 2;1(7814):1253–1254. doi: 10.1016/s0140-6736(73)90570-9. [DOI] [PubMed] [Google Scholar]
  37. Ravid M., Robson M. Proximal myopathy caused by latrogenic phosphate depletion. JAMA. 1976 Sep 20;236(12):1380–1381. [PubMed] [Google Scholar]
  38. Ritz E. Acute hypophosphatemia. Kidney Int. 1982 Jul;22(1):84–94. doi: 10.1038/ki.1982.137. [DOI] [PubMed] [Google Scholar]
  39. Rosenbaum R. W., Hruska K. A., Korkor A., Anderson C., Slatopolsky E. Decreased phosphate reabsorption after renal transplantation: Evidence for a mechanism independent of calcium and parathyroid hormone. Kidney Int. 1981 Apr;19(4):568–578. doi: 10.1038/ki.1981.54. [DOI] [PubMed] [Google Scholar]
  40. Ryback R. S., Eckardt M. J., Pautler C. P. Clinical relationships between serum phosphorus and other blood chemistry values in alcoholics. Arch Intern Med. 1980 May;140(5):673–677. [PubMed] [Google Scholar]
  41. Salassa R. M., Jowsey J., Arnaud C. D. Hypophosphatemic osteomalacia associated with "nonendocrine" tumors. N Engl J Med. 1970 Jul 9;283(2):65–70. doi: 10.1056/NEJM197007092830204. [DOI] [PubMed] [Google Scholar]
  42. Shields H. M. Rapid fall of serum phosphorus secondary to antacid therapy. Gastroenterology. 1978 Dec;75(6):1137–1141. [PubMed] [Google Scholar]
  43. Short E. M., Binder H. J., Rosenberg L. E. Familial hypophosphatemic rickets: defective transport of inorganic phosphate by intestinal mucosa. Science. 1973 Feb 16;179(4074):700–702. doi: 10.1126/science.179.4074.700. [DOI] [PubMed] [Google Scholar]
  44. Silvis S. E., Paragas P. D., Jr Paresthesias, weakness, seizures, and hypophosphatemia in patients receiving hyperalimentation. Gastroenterology. 1972 Apr;62(4):513–520. [PubMed] [Google Scholar]
  45. Sperling M. A. Diabetes mellitus. Pediatr Clin North Am. 1979 Feb;26(1):149–169. doi: 10.1016/s0031-3955(16)33677-x. [DOI] [PubMed] [Google Scholar]
  46. Stoff J. S. Phosphate homeostasis and hypophosphatemia. Am J Med. 1982 Mar;72(3):489–495. doi: 10.1016/0002-9343(82)90520-4. [DOI] [PubMed] [Google Scholar]
  47. Weinsier R. L., Krumdieck C. L. Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited. Am J Clin Nutr. 1981 Mar;34(3):393–399. doi: 10.1093/ajcn/34.3.393. [DOI] [PubMed] [Google Scholar]
  48. Weintraub M. E. Hypophosphatemis mimicking acute Guillanin-Barré-Strohl syndrome. A complication of parenteral hyperalimentation. JAMA. 1976 Mar 8;235(10):1040–1041. [PubMed] [Google Scholar]
  49. Winter R. J., Harris C. J., Phillips L. S., Green O. C. Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med. 1979 Nov;67(5):897–900. doi: 10.1016/0002-9343(79)90751-4. [DOI] [PubMed] [Google Scholar]
  50. Yawata Y., Hebbel R. P., Silvis S., Howe R., Jacob H. Blood cell abnormalities complicating the hypophosphatemia of hyperalimentation: erythrocyte and platelet ATP deficiency associated with hemolytic anemia and bleeding in hyperalimented dogs. J Lab Clin Med. 1974 Nov;84(5):643–653. [PubMed] [Google Scholar]
  51. Youssef H. A. Hypophosphatemic respiratory failure complicating total parenteral nutrition--an iatrogenic potentially lethal hazard. Anesthesiology. 1982 Sep;57(3):246–246. doi: 10.1097/00000542-198209000-00021. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES