hypophosphatemia | overview | definition

  • abnormally low blood phosphate levels
  • symptoms: weakness, trouble breathing, and loss of appetite
  • complications: seizures, coma, rhabdomyolysis, or softening of the bones
  • causes: alcohol use disorder, burns, starvation, and diuretic use
  • diagnosed by a serum phosphate concentration < 2.5 mg/dL (< 0.81 mmol/L)
  • treatment: underlying disorder treatment, oral phosphate replacement, IV phosphate when serum phosphate is < 1 mg/dL

Source:

Betts, J. G., Young, K. A., Wise, J. A., Johnson, E., Poe, B., Kruse, D. H., … DeSaix, P. (n.d.). Anatomy and Physiology. Houston, Texas: OpenStax. Access for free at: https://openstax.org/details/books/anatomy-and-physiology

“Hypophosphatemia”Merck Manuals Professional Edition. Retrieved 28 October 2018.


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Related Topics About Hypophosphatemia

Research Article: Fever as a Cause of Hypophosphatemia in Patients with Malaria

Date Published: December 26, 2007 Publisher: Public Library of Science Author(s): Richard Haber, Warren Browner, Nicholas White. http://doi.org/10.1371/journal.pone.0001380 Abstract: Hypophosphatemia occurs in 40 to 60% of patients with acute malaria, and in many other conditions associated with elevations of body temperature. To determine the prevalence and causes of hypophosphatemia in patients with malaria, we retrospectively studied … Continue reading

Research Article: Antibody-Mediated Activation of FGFR1 Induces FGF23 Production and Hypophosphatemia

Date Published: February 22, 2013 Publisher: Public Library of Science Author(s): Ai-Luen Wu, Bo Feng, Mark Z. Chen, Ganesh Kolumam, Jose Zavala-Solorio, Shelby K. Wyatt, Vineela D. Gandham, Richard A. D. Carano, Junichiro Sonoda, Makoto Makishima. http://doi.org/10.1371/journal.pone.0057322 Abstract The phosphaturic hormone Fibroblast Growth Factor 23 (FGF23) controls phosphate homeostasis by regulating renal expression of sodium-dependent phosphate … Continue reading

Research Article: Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy

Date Published: January , 2011 Publisher: Blackwell Publishing Ltd Author(s): M BROMAN, O CARLSSON, H FRIBERG, A WIESLANDER, G GODALY. http://doi.org/10.1111/j.1399-6576.2010.02338.x Abstract Hypophosphatemia occurs in up to 80% of the patients during continuous renal replacement therapy (CRRT). Phosphate supplementation is time-consuming and the phosphate level might be dangerously low before normophosphatemia is re-established. This study … Continue reading

Research Article: Clinical and genetic characteristics of 15 families with hereditary hypophosphatemia: Novel Mutations in PHEX and SLC34A3

Date Published: March 5, 2018 Publisher: Public Library of Science Author(s): Sezer Acar, Huda A. BinEssa, Korcan Demir, Roua A. Al-Rijjal, Minjing Zou, Gönül Çatli, Ahmet Anık, Anwar F. Al-Enezi, Seçil Özışık, Manar S. A. Al-Faham, Ayhan Abacı, Bumin Dündar, Walaa E. Kattan, Maysoon Alsagob, Salih Kavukçu, Hamdi E. Tamimi, Brian F. Meyer, Ece Böber, … Continue reading

Research Article: Corn-Soy-Blend Fortified with Phosphorus to Prevent Refeeding Hypophosphatemia in Undernourished Piglets

Date Published: January 12, 2017 Publisher: Public Library of Science Author(s): Anne-Louise Hother, Mikkel Lykke, Torben Martinussen, Hanne Damgaard Poulsen, Christian Mølgaard, Per Torp Sangild, André Briend, Christian Fink Hansen, Henrik Friis, Kim F. Michaelsen, Thomas Thymann, Christopher James Johnson. http://doi.org/10.1371/journal.pone.0170043 Abstract Phosphorus (P) levels in refeeding diets are very important as undernourished children are … Continue reading

Research Article: Choice of High-Dose Intravenous Iron Preparation Determines Hypophosphatemia Risk

Date Published: December 1, 2016 Publisher: Public Library of Science Author(s): Benedikt Schaefer, Philipp Würtinger, Armin Finkenstedt, Vickie Braithwaite, André Viveiros, Maria Effenberger, Irene Sulzbacher, Alexander Moschen, Andrea Griesmacher, Herbert Tilg, Wolfgang Vogel, Heinz Zoller, Kostas Pantopoulos. http://doi.org/10.1371/journal.pone.0167146 Abstract Ferric carboxymaltose (FCM) and iron isomaltoside 1000 (IIM) are increasingly used because they allow correction of … Continue reading

Research Article: Increased risk of refeeding syndrome–like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants

Date Published: August 23, 2019 Publisher: Public Library of Science Author(s): Se In Sung, Yun Sil Chang, Jin Hwa Choi, Yohan Ho, Jisook Kim, So Yoon Ahn, Won Soon Park, Olivier Baud. http://doi.org/10.1371/journal.pone.0221042 Abstract Recent nutrition guidelines for extremely-low-birth-weight infants (ELBWIs) recommend implementation of high initial amino acid (AA) supplementation in parenteral nutrition. We sought … Continue reading

Research Article: MEPE-Derived ASARM Peptide Inhibits Odontogenic Differentiation of Dental Pulp Stem Cells and Impairs Mineralization in Tooth Models of X-Linked Hypophosphatemia

Date Published: February 22, 2013 Publisher: Public Library of Science Author(s): Benjamin Salmon, Claire Bardet, Mayssam Khaddam, Jiar Naji, Benjamin R. Coyac, Brigitte Baroukh, Franck Letourneur, Julie Lesieur, Franck Decup, Dominique Le Denmat, Antonino Nicoletti, Anne Poliard, Peter S. Rowe, Eric Huet, Sibylle Opsahl Vital, Agnès Linglart, Marc D. McKee, Catherine Chaussain, Irina Kerkis. http://doi.org/10.1371/journal.pone.0056749 Abstract … Continue reading

osteomalacia | definition

softening of bones due to a lack of mineralization with calcium and phosphate usually due to lack of vitamin D in children, osteomalacia is termed rickets Research Article: Identification of Two Novel Mutations in the PHEX Gene in Chinese Patients with Hypophosphatemic Rickets/Osteomalacia Date Published: May 16, 2014 Publisher: Public Library of Science Author(s): Hua … Continue reading

Research Article: PHEX Mimetic (SPR4-Peptide) Corrects and Improves HYP and Wild Type Mice Energy-Metabolism

Date Published: May 19, 2014 Publisher: Public Library of Science Author(s): Lesya V. Zelenchuk, Anne-Marie Hedge, Peter S. N. Rowe, Dominique Heymann. http://doi.org/10.1371/journal.pone.0097326 Abstract PHEX or DMP1 mutations cause hypophosphatemic-rickets and altered energy metabolism. PHEX binds to DMP1-ASARM-motif to form a complex with α5β3 integrin that suppresses FGF23 expression. ASARM-peptides increase FGF23 by disrupting the … Continue reading


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Related Research Articles From PubMed

Implications of Postpancreatectomy Hypophosphatemia

Background: Electrolyte abnormalities are commonly found after major abdominal surgery for malignancy. We hypothesized that the severity of hypophosphatemia developed in pancreatectomy patients would be associated with the incidence of complications postoperatively.

Methods: A retrospective analysis of an institutional database was conducted for all pancreatic resections (2009-2017). Patient charts were reviewed for demographics, clinicopathologic factors, and perioperative outcomes.

Results: In a cohort of 283 pancreatectomy patients, 107 (37.8%) and 134 (47.3%) developed mild (2.0-2.5 mg/dL) and moderate/severe hypophosphatemia (<2.0 mg/dL), respectively. Nadir serum phosphate levels were shown to occur on postoperative day (POD) 2 for patients without complications and POD3 for patients who had at least 1 complication. Patients who developed severe hypophosphatemia were significantly more likely to suffer fistula-related complications (P = .0401).

Conclusions: Assessing the severity and timing of postpancreatectomy hypophosphatemia presents an opportunity for early detection of impending fistula-related complications.

Keywords: complications; fistula; gastrointestinal; pancreatectomy; postoperative hypophosphatemia.

https://pubmed.ncbi.nlm.nih.gov/32924538/


Hypophosphatemia as an Early Metabolic Bone Disease Marker in Extremely Low Birth Weight Infants After Prolonged Parenteral Nutrition Exposure

Background: Early metabolic bone disease detection is important in preterm infants to decrease long-term consequence. This study aims to explore the early metabolic bone disease biochemical marker in extremely low birth weight infants.

Methods: Retrospective cohort study of 95 preterm infants born in a tertiary-care level neonatal intensive care unit between January 2015 and June 2018 with birth weight less than 1,000 g were conducted. Thirty-five were Nil per os >14 days and categorized as the high-risk group; the remaining 60 were categorized as the control group. Mineral intake in the first 14 days and the trend of serum calcium, phosphorus, and alkaline phosphatase level were compared in both groups.

Results: The calcium and phosphate supplementation in the first 2 weeks of life were inadequate in both groups. Compared to the control group, significantly lower serum phosphorus (mg/dL) levels were noted in the high-risk group on weeks 2 (3.65±1.2 vs. 4.67±1.45, p<0.001), 4 (3.21±0.95 vs. 5.83±1.18, p<0.0001), and 6 (3.94±1.1 vs. 6.22±0.78, p<0.0001). There was no significant difference in the serum calcium level, and significantly higher alkaline phosphatase (U/L) levels were found until 2 months of life in the high-risk group (458.36±189.02 vs. 335.7±111.51, p<0.014).

Conclusions: Hypophosphatemia developed as early as 2 weeks old in high-risk preterm infants due to inadequate supplementation. Neither the serum calcium nor alkaline phosphatase levels are affected. Thus, the routine serum phosphorus level monitoring should be started 2 weeks after birth for early metabolic bone disease detection in extremely low birth weight infants. This article is protected by copyright. All rights reserved.

https://pubmed.ncbi.nlm.nih.gov/32860429/


A rare case of parental iron-induced persistent hypophosphatemia

We report a case of an African American woman who presented with fatigue, generalized weakness, and hypophosphatemia in the setting of a recent hospitalization for severe, symptomatic iron deficiency anemia requiring ferric carboxymaltose infusions. Parental iron is indicated in numerous clinical settings including chronic kidney disease, inflammatory bowel disease, and iron deficiency anemia. Ferric carboxymaltose is one of the most common forms of parental iron infusions used due to administration procedure and minimal reported side effects. The most common side effect reported is a transient decrease in serum phosphate. This case highlights the necessity of monitoring serum phosphate in the setting of parental iron infusions, especially ferric carboxymaltose, and when severe hypophosphatemia occurs management includes intravenous phosphorous and calcitriol.

Keywords: Ferric carboxymaltose; hypophosphatemia; parental iron; phosphate.

https://pubmed.ncbi.nlm.nih.gov/32850057/


Hypophosphatemia in a Specialized Intestinal Failure Unit: An Observational Cohort Study

Background: Patients with intestinal failure (IF) are prone to hypophosphatemia and shifts in magnesium and potassium levels. Although these shifts are often attributed to refeeding syndrome (RFS), the incidence of electrolyte shifts among patients with IF is unknown. We evaluated the occurrence of hypophosphatemia and other electrolyte shifts according to the functional and pathophysiological IF classifications.

Methods: We consecutively included all patients’ first admission to an IF unit from 2013 to 2017. Electrolyte shifts were defined as severe hypophosphatemia <0.6 mmol/L (mM) or any 2 other shifts below reference range, comprising hypomagnesemia <0.75 mM, hypophosphatemia <0.8 mM, or hypokalemia <3.5 mM. Outcomes included length of stay, central line-associated bloodstream infection, and other infections. Mortality was evaluated 6 months after discharge.

Results: Of 236 patients with IF, electrolyte shifts occurred in 99 (42%), and 127 (54%) of these patients received intravenous supplementation with either phosphate, magnesium, or potassium. In patients who started parenteral nutrition, up to 62% of early-onset shifts (<5 days) related to refeeding, and up to 63% of late-onset shifts (≥5 days) could be ascribed to infections. Derangements occurred in 7 (18%) with type 1 IF, 53 (43%) with type 2 IF, and 39 (53%) readmitted patients with type 3 IF. Of 133 patients with IF secondary to short-bowel syndrome, 65 (49%) developed shifts.

Conclusion: In patients with IF, electrolyte shifts are frequent but not always due to RFS. Electrolyte shifts are common in patients with type 2 and those readmitted with type 3 IF.

Keywords: enteral nutrition; hypophosphatemia; intestinal failure; parenteral nutrition.

https://pubmed.ncbi.nlm.nih.gov/32841404/


Comparative Risk of Hypophosphatemia Following the Administration of Intravenous Iron Formulations: A Network Meta-Analysis

Intravenous iron therapy is increasingly used in patients with iron deficiency anemia, although concerns of hypophosphatemia have been recently raised. The aim of this study was to evaluate different intravenous iron formulations for the risk of hypophosphatemia. Medline, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Clinicaltrials.gov, and Google Scholar databases were systematically searched to 20 March 2020. All randomized controlled trials reporting the incidence of hypophosphatemia among adult patients treated with any intravenous iron preparation were included. Pool estimates were obtained by applying an arm-based Bayesian network meta-analysis model. Eight randomized controlled trials were included, comprising 5989 patients. Ferric carboxymaltose was associated with significantly higher incidence of hypophosphatemia compared to iron isomaltoside (risk ratio [RR]: 7.90, 95% confidence interval [CI]: 2.10-28.0), iron sucrose (RR: 9.40, 95% CI: 2.30-33.0), iron dextran (RR: 6.60, 95% CI: 1.91-220.0), and ferumoxytol (RR: 24.0, 95% CI: 2.50-220.0). Therefore, ferric carboxymaltose ranked as the worst treatment presenting the highest surface under the cumulative ranking curve (99.1%). No significant differences were estimated for the comparisons among iron isomaltoside, iron sucrose, iron dextran, and ferumoxytol. In conclusion, it is suggested that the occurrence of hypophosphatemia is common after the administration of intravenous ferric carboxymaltose. Further research is needed in large-scale randomized controlled trials to determine the risk of symptomatic and persistent hypophosphatemia as well as to elucidate the exact pathophysiology of the observed association.

Keywords: Ferric carboxymaltose; Hypophosphatemia; Iron; Meta-analysis; Phosphate.

https://pubmed.ncbi.nlm.nih.gov/32819760/


A rare case of parental iron-induced persistent hypophosphatemia

We report a case of an African American woman who presented with fatigue, generalized weakness, and hypophosphatemia in the setting of a recent hospitalization for severe, symptomatic iron deficiency anemia requiring ferric carboxymaltose infusions. Parental iron is indicated in numerous clinical settings including chronic kidney disease, inflammatory bowel disease, and iron deficiency anemia. Ferric carboxymaltose is one of the most common forms of parental iron infusions used due to administration procedure and minimal reported side effects. The most common side effect reported is a transient decrease in serum phosphate. This case highlights the necessity of monitoring serum phosphate in the setting of parental iron infusions, especially ferric carboxymaltose, and when severe hypophosphatemia occurs management includes intravenous phosphorous and calcitriol.

Keywords: Ferric carboxymaltose; hypophosphatemia; parental iron; phosphate.

https://pubmed.ncbi.nlm.nih.gov/32850057/


[Hypophosphatemia induced by carboxymaltose iron and imatinib. Report of two cases]

Hypophosphatemia is a relatively frequent and a potentially serious adverse drug effect. Clinically it is characterized by bone pain and muscle weakness. There are several mechanisms by which a drug can induce hypophosphatemia and they can be classified according to whether or not they are mediated by an excess of Fibroblast Growth Factor 23 (FGF23). We report two patients with the condition: (i) A 49-year-old woman with Chronic Myeloid Leukemia (CML) and gastric sleeve surgery at 46 years of age. After receiving intravenous carboxymaltose iron in one occasion due to refractory anemia, she developed symptomatic hypophosphatemia. Urinary phosphate losses associated with high FGF23 levels were confirmed. Plasma phosphate returned to normal values 90 days after the iron administration. (ii) A 40-year-old man with a history of CML in whom imatinib was started. He developed symptomatic hypophosphatemia due to non FGF23-mediated hyperphosphaturia. As treatment with imatinib could not be interrupted, hypophosphatemia and its symptoms resolved with oral phosphate intake. These cases illustrate the importance of recognizing and treating drug-induced hypophosphatemia in a timely manner, and thus avoid the morbidity associated with this entity.

https://pubmed.ncbi.nlm.nih.gov/32730387/


Growth Curves for Children with X-linked Hypophosphatemia

Context: We characterized linear growth in infants and children with X-linked hypophosphatemia (XLH).

Objective: Provide linear growth curves for children with XLH from birth to early adolescence.

Design: Data from 4 prior studies of XLH were pooled to construct growth curves. UX023-CL002 was an observational, retrospective chart review. Pretreatment data were collected from 3 interventional trials: two phase 2 trials (UX023-CL201, UX023-CL205) and a phase 3 trial (UX023-CL301).

Setting: Medical centers with expertise in treating XLH.

Patients: Children with XLH, 1-14 years of age.

Intervention: None.

Main outcome measure: Height-for-age linear growth curves, including values for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles for children with XLH compared to population norms.

Results: A total of 228 patients (132 girls, 96 boys) with 2381 height measurements were included. Nearly all subjects (> 99%) reported prior management with supplementation therapy. Compared to the Center for Disease Control and Prevention growth curves, boys at age 3 months, 6 months, 9 months, 1 year, and 2 years had median height percentiles of 46%, 37%, 26%, 18%, and 5%, respectively; for girls the median height percentiles were 52%, 37%, 25%, 18%, and 7%, respectively. Annual growth in children with XLH fell below that of healthy children near 1 year of age and progressively declined during early childhood, with all median height percentiles < 8% between 2 and 12 years old.

Conclusion: Children with XLH show decreased height gain by 1 year of age and remain below population norms thereafter. These data will help evaluate therapeutic interventions on linear growth for pediatric XLH.

https://pubmed.ncbi.nlm.nih.gov/32721016/


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