What is the prevalence of hypophosphatemia in the US?
Hypophosphatemia is typically asymptomatic and is present in up to 5% of patients. It is much more prevalent in alcoholism, diabetic ketoacidosis, or sepsis, with a frequency of up to 80%. The morbidity of hypophosphatemia is highly dependent on its etiology and severity. Pathophysiology
What are the different types of hypophosphatemia?
There are two types of hypophosphatemia: Familial hypophosphatemia is a rare form of the disease that’s passed down through families. This form of the disease can also lead to the bone disease rickets, and a softening of the bones called osteomalacia.
What is hypophosphatemia (low phosphate level)?
Hypophosphatemia is defined as an adult serum phosphate level of less than 2.5 mg/dL. The normal level of serum phosphate in children is considerably higher and 7 mg/dL for infants. Hypophosphatemia is a relatively common laboratory abnormality and is often an incidental finding. [1][2][3][4][5] Cellular
What causes hypophosphatemia?
Causes of hypophosphatemia include: inherited conditions such as X-linked familial hypophosphatemia (XLH) or hereditary hypophosphatemic rickets with hypercalciuria (HHRH) Low phosphate levels may also be due to long term or excess use of certain drugs, such as:
What is the most common cause of hypophosphatemia?
Hypophosphatemia is most often caused by long-term, relatively low phosphate intake in the setting of a sudden increase in intracellular phosphate requirements such as occurs with refeeding. Intestinal malabsorption can contribute to inadequate phosphate intake, especially if coupled with a poor diet.
Who is at risk for hypophosphatemia?
It's common in people who are admitted to the hospital. If you're malnourished from eating disorders, alcoholism or long-lasting diarrhea, you're at greater risk for getting this condition. People with severe burns and complications from diabetes are also at risk.
What level is considered hypophosphatemia?
Hypophosphatemia is defined as an adult serum phosphate level of fewer than 2.5 milligrams per deciliter (mg/dL). The normal level of serum phosphate in children is considerably higher and 7 mg/dL for infants. Hypophosphatemia is a relatively common laboratory abnormality and is often an incidental finding.
What is considered severe hypophosphatemia?
Hypophosphatemia is defined as mild (2-2.5 mg/dL, or 0.65-0.81 mmol/L), moderate (1-2 mg/dL, or 0.32-0.65 mmol/L), or severe (< 1 mg/dL, or 0.32 mmol/L). Mild to moderately severe hypophosphatemia is usually asymptomatic. Major clinical sequelae usually occur only in severe hypophosphatemia.
How do you fix hypophosphatemia?
Mild/moderate acute hypophosphatemia usually can be corrected with increased dietary phosphate or oral supplementation, but intravenous replacement generally is needed when significant comorbid conditions or severe hypophosphatemia with phosphate depletion exist.
Why do my phosphate levels keep dropping?
Long-term starvation, malnutrition, and anorexia can deplete the body's stores of phosphorous over time. Acute hypophosphatemia is especially common in hospital patients undergoing refeeding. Additional causes include chronic infections, Crohn's disease, or malignant tumors.
Is low phosphate common?
Because phosphate is found in many foods, it's rare to have a deficiency — unless you're malnourished. Certain medical conditions can cause hypophosphatemia by: decreasing the amount of phosphate your intestines absorb.
How is hypophosphatemia inherited?
In most individuals, familial hypophosphatemia is inherited in an X-linked dominant manner, however variant forms may be inherited in an autosomal dominant or recessive manner.
When do you treat hypophosphatemia?
Treatment of Hypophosphatemia Treatment of the underlying disorder and oral phosphate replacement are usually adequate in asymptomatic patients, even when the serum concentration is very low.
What kind of doctor treats hypophosphatemia?
A nephrologist can help confirm the likelihood of phosphate wasting and can help assess the patient for causes of renal phosphate wasting.
What is a critical phosphorus level?
Soft tissue calcification is also an important long-term effect of high phosphorus levels. Phosphorus levels below 1.0 mg/dL are potentially life-threatening and are considered a critical value in the Mayo Health System.
What causes hypophosphatemia?
Acute hypophosphatemia is usually the more severe and common type of hypophosphatemia seen in clinical settings. Its causes include: 1 Recovery from diabetic ketoacidosis. Diabetic ketoacidosis happens when someone mismanages their diabetes or might not realize they have it. It is a state that the body goes into when it is unable to produce enough insulin. Insulin is what helps your body break fat down and burn it as fuel. When you go into diabetic ketoacidosis, you have a buildup of acids in your bloodstream, leading to loss of consciousness or even death. 2 Chronic Alcoholism. It is believed that over time, alcoholism hampers your kidney’s ability to absorb phosphorus fully. This is one of the most common causes of hypophosphatemia. Fifty percent of people who are hospitalized due to alcoholism develop hypophosphatemia within the first three days of their hospitalization. 3 Burns. Phosphate is a source of intracellular energy, and when someone experiences a severe burn, their phosphate levels dip dangerously low. Therefore, patients must receive supplemental phosphate to stay healthy. 4 Respiratory alkalosis. This is a decreased amount of carbon dioxide pressure without increased bicarbonate. It usually happens when you hyperventilate or simply breathe in and out too quickly. Respiratory alkalosis causes acute hypophosphatemia because your cells naturally begin to shift around the phosphate stores in your bones. This cause of acute hypophosphatemia is different than the other causes because it will immediately return to normal once the hyperventilation stops.#N#
Why does respiratory alkalosis cause hypophosphatemia?
Respiratory alkalosis causes acute hypophosphatemia because your cells naturally begin to shift around the phosphate stores in your bones. This cause of acute hypophosphatemia is different than the other causes because it will immediately return to normal once the hyperventilation stops. . Chronic Hypophosphatemia.
What causes phosphorus to deplete?
Long-term starvation, malnutrition, and anorexia can deplete the body’s stores of phosphorous over time. Acute hypophosphatemia is especially common in hospital patients undergoing refeeding. Additional causes include chronic infections, Crohn’s disease, or malignant tumors. Hyperparathyroidism.
What is the normal phosphorus level?
Phosphorous is a mineral found in your bones that helps to keep your bones and body healthy. Normal blood phosphorous levels are between 2.5 to 4.5 mg/dL. Hypophosphatemia is a condition in which your blood has a low level of phosphorous. Low levels can cause a host of health challenges, including muscle weakness, respiratory or heart failure, ...
Why do people need phosphate?
Phosphate is a source of intracellular energy, and when someone experiences a severe burn, their phosphate levels dip dangerously low. Therefore, patients must receive supplemental phosphate to stay healthy. Respiratory alkalosis. This is a decreased amount of carbon dioxide pressure without increased bicarbonate.
Can antacids cause hypophosphatemia?
Long-term use of diuretics and antacids can significantly impact the kidney’s ability to absorb phosphorous. Symptoms. As stated previously, hypophosphatemia is always caused by an underlying condition. However, often it is asymptomatic.
Can low phosphate levels cause comas?
Low levels can cause a host of health challenges, including muscle weakness, respiratory or heart failure, seizures, or comas. The cause of hypophosphatemia is always from some other underlying issue. It is a severe condition, and you must treat the underlying issue to prevent some of the very severe repercussions of having hypophosphatemia.
How does hypophosphatemia occur?
Hypophosphatemia is caused by the following three mechanisms: 1 Inadequate intake (often unmasked in refeeding after long-term low phosphate intake) 2 Increased excretion (e.g. in hyperparathyroidism, hypophosphatemic rickets) 3 Shift of phosphorus from the extracellular to the intracellular space. This can be seen in treatment of diabetic ketoacidosis, refeeding, short-term increases in cellular demand (e.g. hungry bone syndrome) and acute respiratory alkalosis.
What causes hypophosphatemia?
Hypophosphatemia is caused by the following three mechanisms: Inadequate intake (often unmasked in refeeding after long-term low phosphate intake) Increased excretion ( e.g. in hyperparathyroidism, hypophosphatemic rickets) Shift of phosphorus from the extracellular to the intracellular space.
How is phosphate given?
Phosphate may be given by mouth or by injection into a vein. Hypophosphatemia occurs in about 2% of people within hospital and 70% of people in the intensive care unit (ICU).
Why do cells need phosphate?
Causes. Refeeding syndrome – This causes a demand for phosphate in cells due to the action of hexokinase, an enzyme that attaches phosphate to glucose to begin metabolism of glucose. Also, production of ATP when cells are fed and recharge their energy supplies requires phosphate.
What causes rhabdomyolysis in white blood cells?
White blood cell dysfunction, causing worsening of infections. Instability of cell membranes due to low adenosine triphosphate (ATP) levels – This may cause rhabdomyolysis with increased serum levels of creatine phosphokinase, and also hemolytic anemia. Increased affinity for oxygen in the blood caused by decreased production ...
Is potassium phosphate a supplement?
Supplementation by mouth is also useful where no intravenous treatment are available. Historically one of the first demonstrations of this was in people in concentration camp who died soon after being re-fed: it was observed that those given milk (high in phosphate) had a higher survival rate than those who did not get milk.
Does alcohol cause hypophosphatemia?
In addition, alcohol treatment is associated with refeeding, which further depletes phosphate, and the stress of alcohol withdrawal may create respiratory alkalosis, which exacerbates hypophosphatemia (see above).
Hypophosphatemia Symptoms
Hypophosphatemia may not show any symptoms in the early stages. 3 In severe cases, you may notice the following: 4
Causes
Hypophosphatemia can be caused by health conditions, medical treatments, or malnutrition. They include. 6
Diagnosis
Hypophosphatemia is diagnosed by a blood test to check phosphate levels. You have the condition if levels are 2.5 mg/dL or less. 2 If the cause is unclear, your doctor may test vitamin D levels, liver function, and kidney function. 4
Treatment
If blood tests show that you have hypophosphatemia, you’ll be treated for the disorder causing it and given phosphate-replacement treatment.
Prognosis
Outcomes depend on what caused the hypophosphatemia. 4 If the cause is chemotherapy drugs, keeping phosphate at or above normal levels will help. Treating the condition that caused hypophosphatemia, such as diabetic ketoacidosis, will also help get levels back to normal.
Summary
Hypophosphatemia is a condition in which phosphate levels decrease below 2.5 mg/dL. When phosphate levels get too low, your heart, lungs, and brain can be damaged. Medical conditions, medications, injury, and lifestyle can cause hypophosphatemia. These include severe burns, diabetic ketoacidosis, alcohol use disorder, and chemotherapy drugs.
A Word From Verywell
Early stages of hypophosphatemia may not show any symptoms. You may find out you have it during routine blood work. Or perhaps you have diabetes and develop hypophosphatemia during treatment for diabetic ketoacidosis. In either case, phosphate-replacement treatment can return phosphate levels to normal.
Overview
Causes
• Refeeding syndrome – This causes a demand for phosphate in cells due to the action of hexokinase, an enzyme that attaches phosphate to glucose to begin metabolism of glucose. Also, production of ATP when cells are fed and recharge their energy supplies requires phosphate. A similar mechanism is seen in the treatment of diabetic ketoacidosis, which can be complicated by respiratory failure in these cases due to respiratory muscle weakness.
Signs and symptoms
• Muscle dysfunction and weakness – This occurs in major muscles, but also may manifest as: diplopia, low cardiac output, dysphagia, and respiratory depression due to respiratory muscle weakness.
• Mental status changes – This may range from irritability to gross confusion, delirium, and coma.
Pathophysiology
Hypophosphatemia is caused by the following three mechanisms:
• Inadequate intake (often unmasked in refeeding after long-term low phosphate intake)
• Increased excretion (e.g. in hyperparathyroidism, hypophosphatemic rickets)
• Shift of phosphorus from the extracellular to the intracellular space. This can be seen in treatment of diabetic ketoacidosis, refeeding, short-term increases in cellular demand (e.g. hungry bone syndrome) and acute respir…
Diagnosis
Hypophosphatemia is diagnosed by measuring the concentration of phosphate in the blood. Concentrations of phosphate less than 0.81 mmol/L (2.5 mg/dL) are considered diagnostic of hypophosphatemia, though additional tests may be needed to identify the underlying cause of the disorder.
Treatment
Standard intravenous preparations of potassium phosphate are available and are routinely used in malnourished people and people who consume excessive amounts of alcohol. Supplementation by mouth is also useful where no intravenous treatment are available. Historically one of the first demonstrations of this was in people in concentration camp who died soon after being re-fed: it was observed that those given milk (high in phosphate) had a higher survival rate than those wh…
See also
• X-linked hypophosphatemia
Hypophosphatemia Symptoms
Causes
Diagnosis
- Hypophosphatemia is diagnosed by a blood test to check phosphate levels. You have the condition if levels are 2.5 mg/dL or less.2 If the cause is unclear, your doctor may test vitamin D levels, liver function, and kidney function.4
Treatment
- If blood tests show that you have hypophosphatemia, you’ll be treated for the disorder causing it and given phosphate-replacement treatment.
Prognosis
- Outcomes depend on what caused the hypophosphatemia.4If the cause is chemotherapy drugs, keeping phosphate at or above normal levels will help. Treating the condition that caused hypophosphatemia, such as diabetic ketoacidosis, will also help get levels back to normal.
Summary
- Hypophosphatemia is a condition in which phosphate levels decrease below 2.5 mg/dL. When phosphate levels get too low, your heart, lungs, and brain can be damaged. Medical conditions, medications, injury, and lifestyle can cause hypophosphatemia. These include severe burns, diabetic ketoacidosis, alcohol use disorder, and chemotherapy drugs. Outcom...
A Word from Verywell
- Early stages of hypophosphatemia may not show any symptoms. You may find out you have it during routine blood work. Or perhaps you have diabetes and develop hypophosphatemia during treatment for diabetic ketoacidosis. In either case, phosphate-replacement treatment can return phosphate levels to normal. You can lessen your chances of getting hypophosphatemia. If you h…