Causes of hypophosphatemia
- Alan S L Yu, MB, BChir
Alan S L Yu, MB, BChir
- Harry Statland and Solon Summerfield Professor of Medicine
- University of Kansas Medical Center
- Jason R Stubbs, MD
Jason R Stubbs, MD
- Associate Professor of Medicine
- Division of Nephrology & Hypertension
- University of Kansas Medical Center
The reported prevalence of hypophosphatemia varies widely, depending upon the patient population surveyed and the concentration of serum phosphorus used to define hypophosphatemia. Up to 5 percent of hospitalized patients may have low serum phosphate concentrations (less than 2.5 mg/dL [0.80 mmol/L]), although prevalences of over 30 to 50 percent have been reported in alcoholic patients and patients with severe sepsis or trauma [1-3]. Profound hypophosphatemia (less than 1 mg/dL [0.32 mmol/L]), which can lead to physiological disturbances and symptoms, is much less common [3-5]. (See "Signs and symptoms of hypophosphatemia".)
There are four major mechanisms by which hypophosphatemia can occur (table 1):
●Redistribution of phosphate from the extracellular fluid into cells
●Decreased intestinal absorption of phosphate
●Increased urinary phosphate excretion
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- INTERNAL REDISTRIBUTION
- Increased insulin secretion, particularly during refeeding
- Acute respiratory alkalosis
- Hungry bone syndrome
- DECREASED INTESTINAL ABSORPTION
- Inadequate intake
- Steatorrhea and chronic diarrhea
- INCREASED URINARY EXCRETION
- Primary and secondary hyperparathyroidism
- Vitamin D deficiency or resistance
- Primary renal phosphate wasting
- Fanconi syndrome
- RENAL REPLACEMENT THERAPY