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Phosphate Deficiency and the Phosphate-Depletion Syndrome: Pathophysiology, Diagnosis, and Treatment

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Clinical Aspects of Natural and Added Phosphorus in Foods

Part of the book series: Nutrition and Health ((NH))

Abstract

Phosphorus depletion describes a state of substantial phosphorus deficiency within all body compartments. Most, but not all times, it is accompanied by hypophosphatemia, a serum phosphorus level of <2.5 mg/dl (<0.81 mmol/L). While hypophosphatemia is rare in the general population, among hospitalized patients, there are several high-risk subgroups, including alcoholics and the severely malnourished (e.g., those with anorexia nervosa and malignancy) [1, 2]. As phosphorus-containing ATP forms the basis of energy that is essential to most physiologic processes, significant deficiency in this element is a threat to health. Severe hypophosphatemia (≤1.0 mg/dl) has been linked to the syndrome of phosphorus depletion, characterized symptomatically by weakness, muscle and bone pain, and anorexia [3]. Animal data, human case reports, and observational human studies have demonstrated multisystem effects, including respiratory and cardiac muscle dysfunction, rhabdomyolysis, osteomalacia, and hemolysis [4]. Given the diverse and central role of phosphorus, intuition would suggest that the phosphorus-depletion syndrome enhances risk for mortality, especially in the critically ill patient. However, while observational data shows an association between severe hypophosphatemia and mortality, confounding by a variety of comorbid conditions in the critically ill makes causality difficulty to prove [2].

In addition, the exact clinical and laboratory threshold at which a patient becomes at risk for the syndrome is unknown. Hence, it is paramount to recognize the constellation of symptoms and signs and identify the risk factors for development of phosphate-depletion syndrome.

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Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Drexel University College of Medicine, 245 N. 15th St. Mailstop 437, Philadelphia, PA, 19102, USA

    Suzanne M. Boyle MD

  2. Renal, Hypertension, and Electrolyte Division, Perelman School Medicine, University of Pennsylvania, 100 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, PA, 19104, USA

    Stanley Goldfarb MD

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  1. Suzanne M. Boyle MD
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Correspondence to Suzanne M. Boyle MD .

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Editors and Affiliations

  1. University of Alabama at Birmingham, Department of Medicine, School of Medicine, Birmingham, Alabama, USA

    Orlando M. Gutiérrez

  2. City Tower, Suite 400-ZOT:4088 UCI, School of Medicine, Orange, California, USA

    Kamyar Kalantar-Zadeh

  3. University of Washington, Professor of Medicine, and Section Head Harborview Medical Center, Seattle, Washington, USA

    Rajnish Mehrotra

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Boyle, S.M., Goldfarb, S. (2017). Phosphate Deficiency and the Phosphate-Depletion Syndrome: Pathophysiology, Diagnosis, and Treatment. In: Gutiérrez, O., Kalantar-Zadeh, K., Mehrotra, R. (eds) Clinical Aspects of Natural and Added Phosphorus in Foods. Nutrition and Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6566-3_11

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  • DOI: https://doi.org/10.1007/978-1-4939-6566-3_11

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-6564-9

  • Online ISBN: 978-1-4939-6566-3

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