Hypophosphataemia

Hypophosphataemia is a common electrolye abnormality and is often an incidental finding. It is defined by serum phosphate concentration below the lower limit of normal.

• 0.8 - 1.5 mmol/L

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Causes

Decreased intake

• Malnutrition
• Alcoholism
• Malabsorption (bariatric surgery, Chron’s, diarrhoea)
• Ingestion of phosphate binding compounds

Increased excretion

• Hyperparathyroidism
• Vitamin D deficiency
• Fibroblast growth factor 23 dependent pathology
• AKI
• ATN (recovery)
• Fanconi syndrome
• Renal transplant
• Medication

Redistribution

• Refeeding syndrome
• Respiratory alkalosis
• Dialysis
• Catecholamines
• Thyrotoxic periodic paralysis
• Cincalet
• Post-parathyroidectomy effect (Hungry bone syndrome)
• Diabetic ketoacidosis and alcoholic metabolic acidosis
• Poorly controlled diabetes
• Vitamin D deficiency, resistance, or failure of hydroxylation (hepatic causes)

Complications

• Heart failure
• Arrhythmia
• Cardiogenic shock
• Acute tubular necrosis
• Metabolic acidosis
• Rhabdomyolysis
• Diaphragmatic (and other muscle) weakness
• Tetany
• Delerium and coma
• Seizure
• Hyperglycaemia and insulin resistance
• Haemolysis
• Platelet dysfunction and/or thrombocytopaenia
• Leukocyte dysfunction
• Decrease 2,3-BPG syntesis

Further reading