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Hypophosphatemia in the alcoholic patient

Alan S L Yu, MB, BChir
Jason R Stubbs, MD
Section Editor
Stanley Goldfarb, MD
Deputy Editor
Albert Q Lam, MD


The alcoholic patient is prone to severe hypophosphatemia, particularly when admitted to the hospital. However, the fall in the serum phosphate concentration may not become prominent until 12 to 36 hours after admission. This sequence is due to underlying chronic phosphate depletion, complicated by acute shifts of phosphate into the intracellular compartment. (See 'Etiology' below.)

The causes and treatment of hypophosphatemia in the alcoholic patient will be reviewed here. The major causes of hypophosphatemia; the clinical manifestations of hypophosphatemia, most of which are due to intracellular phosphate depletion; and the diagnosis and treatment of hypophosphatemia in the general population are discussed elsewhere. (See "Causes of hypophosphatemia" and "Signs and symptoms of hypophosphatemia" and "Evaluation and treatment of hypophosphatemia".)


Hypophosphatemia can result from reduced intestinal phosphate absorption and/or increased phosphate excretion (table 1) [1]. Both mechanisms may be operative in patients who abuse alcohol:

Decreased intestinal phosphate absorption can result from poor dietary intake of both phosphate and vitamin D; binding of dietary phosphate by antacids given to treat recurring gastritis (eg, calcium carbonate); and/or reduced net intestinal phosphate absorption, which may be induced by chronic diarrhea. (See "Causes of hypophosphatemia", section on 'Decreased intestinal absorption'.)

Increased urinary phosphate excretion due to reduced proximal phosphate reabsorption can result from secondary hyperparathyroidism induced by vitamin D deficiency; therefore, 25(OH)D levels should be measured in alcoholic patients exhibiting hypophosphatemia. Alternatively, alcohol may directly promote urinary phosphate wasting by causing generalized proximal tubule dysfunction, which results in reduced phosphate reabsorptive capacity in the nephron. This proximal tubule dysfunction typically improves within days of abstinence from alcohol [2]. The physiology of phosphate handling within the nephron is discussed elsewhere. (See "Causes of hypophosphatemia", section on 'Increased urinary excretion'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 11, 2016.
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