Hypophosphatemia is a common laboratory abnormality that occurs in a wide variety of disorders. Hypophosphatasia develops from a mutation in the gene alpl, which encodes for alkaline phosphatase, an important enzyme that breaks down certain chemicals. The normal level for serum phosphate in neonates and children is considerably higher, up to 7 mgdl for infants. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. In a healthy 70kg adult, the total body phosphorus content is around 700 g 23 000 mmol, of which about 80% is present in the skeleton as crystalline hydroxyapatite ca 10 po 4 6 oh 2, 9% in the skeletal muscle, 10. Hypophosphatemia is also associated with other medical conditions of which hyperventilation is a feature, such as sepsis, heat stroke and hepatic coma. Routine labs during his rehab stay revealed hyperphosphatemia, with a phosphate level of 5. Hypophosphatemiarelated to drugtreatment can be caused by several medications. Malabsorption of phosphorus is often secondary to inflammatory states, surgery, or diarrhea. Hypophosphatemia can be associated with a number of conditions including bone diseases and hormone conditions. Approach to treatment of hypophosphatemia american journal. Hypophosphatemia is defined as an adult serum phosphate level of less than 2. Treatment of hypophosphatemia in the intensive care unit. Hypophosphatemia merck manuals professional edition.
If the patient has vitamin d deficiency due to druginduced metabolism, discontinuation of the. The commonly associated factors in most patients with hypophosphatemia were. Clinical features include muscle weakness, respiratory failure, and heart failure. Renal tubular disorders, including fanconis syndrome, dents disease. Figure 1 causes and effects of hypophosphatemiaphosphate depletion. For both of these reasons, patients who are hypophosphatemic may be slow to wean from mechanical ventilation.
Phosphate metabolism and causes of hypophosphatemia. Phosphate is an electrolyte that helps your body with energy production and nerve function. Increased urinary phosphate excretion to continue reading this article, you must log in with your personal, hospital. Hypophosphatemia is an electrolyte disorder in which there is a low level of phosphate in the blood.
Hypophosphatemia can occur when there are increased losses, decreased intake, or cellular shifts of phosphate. Hypophosphatemia resulting from poor intake is uncommon, because phosphorus is plentiful in the diet. Various medical conditions may cause hypophosphatemia, but it is commonly associated with starvation and alcoholism. Phosphate is required by the red blood cells for producing 2,3diphosphoglycerate which is used for releasing oxygen from the hemoglobin. Pdf fever as a cause of hypophosphatemia in patients. Apr 21, 2011 hypophosphatemia is commonly missed due to nonspecific signs and symptoms, but it causes considerable morbidity and in some cases contributes to mortality. Serum inorganic phosphorus pi concentrations are generally maintained at 2. The reason why war erupted is actually much more complicated than a simple list of causes.
Overview of chronic kidney diseasemineral and bone disorder ckdmbd prevention and treatment of heme pigmentinduced acute kidney injury. In the majority of cases, the symptoms related to hypophosphatemia are. Hypophosphatemia is a serum phosphate concentration causes include alcoholism, burns, starvation, and diuretic use. It can occur, however, when an individual has been chronically and severely malnourished. Chronic alcoholism use of antacids use of certain medications like acetazolamide, pentamidine, etc medical condition called as fanconi syndrome malnourishment or excessive starvation low vitamin d levels hyperparathyroidism. Since hypophosphatemia can be attributed to many other causes, the diagnosis of druginduced hypocalcemia may easily be overlooked. Complications may include seizures, coma, rhabdomyolysis, or softening of the bones. Symptoms occur only when hypophosphatemia is very severe and include muscle weakness that may progress to coma and death. Causes of world war i world war i occurred between july 1914 and november 11, 1918. Disorders of calcium, magnesium, and phosphate balance. Redistribution of phosphate from the extracellular fluid into cells.
True hypophosphatemia can be induced by decreased net intestinal absorption, increased urinary phosphate excretion, or acute movement of extracellular phosphate into the cells. Hypophosphatemia, reduction in the concentration of phosphate in the blood serum, thus disrupting the bodys energy metabolism and impairing the delivery of oxygen through the bloodstream to the tissues. Phosphorus is an essential mineral that is usually found in nature combined with oxygen as phosphate. Vitamin d deficiency, including hypophosphataemic rickets. Hypophosphatemia is also seen in approximately one third of hematopoietic cell transplantation, but, in this setting, it correlates highly with mortality. Hypophosphatemia is defined as serum phosphate levels below 2. If the patient has vitamin d deficiency due to druginduced metabolism, discontinuation of the drug should be considered.
Hypophosphatemia means low levels of phosphorus in the blood. Hyperphosphatemia in the absence of ckd nyu langone. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Hypophosphatemia endocrine and metabolic disorders merck. Hypophosphatemia endocrine and metabolic disorders. Hypophosphatemia may be acute or chronic and results from decreased intake andor absorption, gastrointestinal and renalextracorporeal losses, internal redistribution, or a combination of these factors. Xlinked hypophosphatemia, also known as vitamin dresistant rickets, is an inherited disorder characterized by low levels of phosphate in the blood due to abnormal processing in the kidney, leading to phosphate wasting and resulting in soft, weak bones rickets. For hospitalized adolescents with an, most authors consider an episode of hypophosphatemia to be a serum phosphorus level 3 mgdl 1 mmoll 33e35. Management of hyperphosphatemia in adults with chronic kidney disease. Hypophosphatemia wikimili, the best wikipedia reader. Pdf on jul 24, 2018, sandeep sharma and others published. Pdf treatment of hypophosphatemia in the intensive care.
It can cause bone deformity including short stature and genu varum bowleggedness. For language access assistance, contact the ncats public information officer. Blood cell abnormalities complicating the hypophosphatemia of hyperalimentation. All authors approved the final version of the manuscript. Hypophosphatemia is a low level of phosphorus in the blood. Causes of hypophosphatemia causes of vitamin d deficiency related topics. As of today we have 77,375,193 ebooks for you to download for free. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. Fever as a cause of hypophosphatemia in patients with malaria. Hypophosphatemia metabolic disorders merck veterinary manual.
By the end of the war, over 17 million people would be killed including over 100,000 american troops. Up to 5 percent of hospitalized patients may have low serum phosphate concentrations less than 2. Phosphate levels are low because phosphate is abnormally processed in the kidneys, which causes a loss of phosphate in the urine phosphate wasting and leads to soft, weak bones. Pdf fever as a cause of hypophosphatemia in patients with. Severe hypophosphatemia may cause tissue hypoxia and rhabdomyolysis. Most hospitalized adolescents with an have serum phosphorus. There are four major mechanisms by which hypophosphatemia can occur table 1.
Feb 23, 2018 xlinked hypophosphatemia xlh is an inherited disorder characterized by low levels of phosphate in the blood. Html and as a pdf that can be viewed andor printed using adobe acrobat reader. Hypophosphatemic rickets genetic and rare diseases. Hypophosphatemia in hospitalized patients david juan, md, mohamed a. Three primary mechanisms of hypophosphatemia exist. Xlinked hypophosphatemia genetic and rare diseases.
Hypophosphatemia is defined as a phosphate level of less than 2. Dec 04, 2017 hypophosphatemia is an abnormally low level of phosphate in the blood. When severe and prolonged, it may be associated with rhabdomyolysis, brain dysfunction, myocardial failure and certain defects of erythrocyte function and. The most common cause of hypophosphatemia is chronic alcoholism. Refeeding hypophosphatemia in hospitalized adolescents with. Deficient serum phosphate levels functions of phosphate. Mild to moderately severe, asymptomatic hypophosphatemia spontaneously normalizes over several days when factors inducing are corrected. Spurious hypophosphatemia can be caused by interference of paraproteins or medications with the phosphate assay. Hypophosphatemia causes manifestations treatment decreased gi absorption o starvation, o malabsorption o vitamin d deficiency, o phosphate binding antacids i. The sudden onset of phosphorus losses through the mammary gland at the onset of lactation and the decreased feed intake around parturition are believed to be the major contributors to periparturient hypophosphatemia of dairy cows. Read more about symptoms, diagnosis, treatment, complications, causes and. Recognize the causes and symptoms of hypophosphatemia and select. Also of note, hypophosphatemia causes a leftward shift of the oxyhemoglobin curve increased affinity for oxygen.
No annoying ads, no download limits, enjoy it and dont forget to bookmark and share the love. Dec 12, 2019 hypophosphatemia is defined as a phosphate level of less than 2. Elrazak, md hypophosphatemia is common in hospitalized patients and occurs under a variety of circumstances other than parathyroid hormone excess. Acute phosphorus losses associated with hypophosphatemia are a wellrecognized problem in highyielding dairy cows at the onset of lactation. Case report hypophosphatemic osteomalacia induced by. Mar 01, 2016 if you have problems viewing pdf files, download the latest version of adobe reader. Hypophosphataemia is common after renal transplantation, especially after long periods of dialysis. Exists primarily in inorganic combinations with calcium in teeth and bones supports in the extracellular fluid several metabolic functions, including use of b vitamins, acidbase homeostasis, bone formation, nerve and muscle activity, cell division, transmission of hereditary traits, and metabolism of carbohydrates, proteins, and fats. Jul 29, 2019 high salt load causes reduced reabsorption of sodium by the proximal tubule but also reduced phosphate reabsorption. Xlinked hypophosphatemia xlh, is an xlinked dominant form of rickets or osteomalacia that differs from most cases of rickets in that vitamin d supplementation does not cure it. Management of secondary hyperparathyroidism in adult dialysis patients.
Hypophosphatemia in critically ill children scielo. As previously stated, hypophosphatemias most common causes are. Hypophosphatemia is defined as a plasma phosphate level causes of hypophosphatemia are shown in table 1. The symptoms and the hypophosphatemia improved after discontinuation of adv coupled with supplementation with phosphate in most cases.
400 907 130 413 818 937 377 1085 1292 188 1034 388 365 1409 1327 1097 1030 340 78 451 263 310 457 1172 144 579 341 1188 511 868 39 717 146