Skip to main content
SpringerLink
Log in

Incidence and aetiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

Hypophosphatemia is a common finding in patients in the intensive care unit (ICU). Its cause is often poorly understood.

Purpose

The aim of this study was to understand the incidence of renal phosphate loss in ICU-related hypophosphatemia, and to examine the role of phosphaturic hormones in its etiology.

Methods

Plasma phosphate levels were measured on day 1, 3, 5 and 7 in 290 consecutive patients admitted to the ICU. Renal phosphate handling and phosphaturic hormones were studied in a subset of patients with phosphate levels <0.6 mmol/L. Renal phosphate loss was defined as a TmP/gfr < 0.6 mmol/L.

Main Results

Hypophosphatemia developed in 24 % of all patients. This mainly occurred within the first 3 days of stay and in patients with serum creatinine levels <150 μmol/L. Renal phosphate loss was present in 80 % of patients who developed hypophosphatemia, and was not related to serum levels of parathyroid hormone (PTH), PTH-related protein (PTH-rp), fibroblast growth factor 23 (FGF-23), or calcitonin.

Conclusion

Hypophosphatemia in the ICU is commonly associated with renal phosphate loss. It mainly occurs within the first 3 days of admission, in particular in patients with preserved renal function. Renal phosphate loss is not explained by elevated PTH, PTH-rp, FGF-23 or calcitonin levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Charron T, Bernard F, Skrobik Y, Simoneau N, Gagnon N, Leblanc M (2003) Intravenous phosphate in the intensive care unit: more aggressive repletion regimens for moderate and severe hypophosphatemia. Intensive Care Med 29:1273–1278

    Article  PubMed  Google Scholar 

  2. Srinivasagam D, Seshadri MS, Peter JV, Cherian AM, Charles D, Kanagasabapathy AS (1992) Prevalence & pathogenesis of hypophosphatemia in ventilated patients. Indian J Med Res 96:87–90

    PubMed  CAS  Google Scholar 

  3. Barak V, Schwartz A, Kalickman I, Nisman B, Gurman G, Shoenfeld Y (1998) Prevalence of hypophosphatemia in sepsis and infection: the role of cytokines. Am J Med 104(1):40–47

    Article  PubMed  CAS  Google Scholar 

  4. Geerse A, Bindels A, Kuiper M, Roos A et al (2010) Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care 14:R 147

    Article  Google Scholar 

  5. Suzuki S, Egi M, Schneider AG, Bellomo R, Hart GK, Hegarty C (2012) Hypophosphatemia in critically ill patients. J Crit Care, Dec 19

    Google Scholar 

  6. Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelamn M (2010) Association of hypophosphatemia with failure to wean from mechanical ventilation. Ann Clin Lab Sci 40(2):144–148

    PubMed  CAS  Google Scholar 

  7. Bollaert PE, Levy B, Nace L, Laterre PF, Larcan A (1995) Hemodynamic and metabolic effects of rapid correction of hypophosphatemia in patients with septic shock. Chest 107:1698–1701

    Article  PubMed  CAS  Google Scholar 

  8. Murer H, Homer Smith Award (1992) Cellular mechanisms in proximal tubular Pi reabsorption: some answers and more questions. J Am Soc Nephrol 2(12):1649–1665

    PubMed  CAS  Google Scholar 

  9. Bugg NC, Jones JA (1998) Hypophosphatemia. Pathophysiology, effects and management on the intensive care unit. Anaesthesia 53(9):895–902

    Article  PubMed  CAS  Google Scholar 

  10. Schlüter KD (1999) PTH and PTHrP: similar structures but different functions. News Physiol Sci 14:243–249

    PubMed  Google Scholar 

  11. Fukumoto S (2008) Physiological regulation and disorders of phosphate metabolism pivotal role of fibroblast growth factor 23. Intern Med 47:337–343

    Article  PubMed  Google Scholar 

  12. Bijvoet OL (1969) Relation of plasma phosphate concentration to renal tubular reabsorption of phosphate. Clin Sci 37(1):23–36

    PubMed  CAS  Google Scholar 

  13. Yamazawa K, Kodo K, Maeda J, Omori S, Hida M, Mori T, Awazu M (2006) Hyponatremia, hypophosphatemia, and hypouricemia in a girl with macrophage activation syndrome. Pediatrics 118(6):2557–2560

    Article  PubMed  Google Scholar 

  14. Zwaveling JH, Hoekstra HJ, Maring JK, v Ginkel RJ, Schraffordt Koops H, Smit AJ, Girbes AR (1997) Renal function in cancer patients treated with hyperthermic isolated limb perfusion with recombinant tumor necrosis factor-alpha and melphalan. Nephron 76(2):146–152

    Article  PubMed  CAS  Google Scholar 

  15. Lee JW (2010) Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press 8(2):72–81

    Article  PubMed  CAS  Google Scholar 

  16. Zivin JR, Gooley T, Zager RA, Ryan MJ (2001) Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Dis 37(4):689–698

    Article  PubMed  CAS  Google Scholar 

  17. Zaloga GP (1992) Hypocalcemia in critically ill patients. Crit Care Med 20(2):251–262

    Article  PubMed  CAS  Google Scholar 

  18. Chernow B (1990) Calcium: does it have a therapeutic role in sepsis? Crit Care Med 18(8):895–896

    Article  PubMed  CAS  Google Scholar 

  19. Zaloga GP, Washburn D, Black KW, Prielipp R (1993) Human sepsis increases lymphocyte intracellular calcium. Crit Care 21(2):196–202

    Article  CAS  Google Scholar 

  20. Whitted AD, Stanifer JW, Dube P, Borkowski BJ, Yusuf J, Komalafe BO, Davis RC, Soberman JE, Weber KT (2010) A dyshomeostasis of electrolytes and trace elements in acute stressor states: impact in the heart. Am J Med Sci 340(1):48–53

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands

    Anneke Bech & Hans de Boer

  2. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Michiel Blans

  3. Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands

    Darryl Telting

Authors
  1. Anneke Bech
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michiel Blans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darryl Telting
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans de Boer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anneke Bech.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bech, A., Blans, M., Telting, D. et al. Incidence and aetiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit. Intensive Care Med 39, 1785–1791 (2013). https://doi.org/10.1007/s00134-013-2970-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-013-2970-4

Keywords

Search

Navigation