Should Hypophosphatemia be Treated?
The answer to the question is yes. Phosphate treatment is necessary when hypophosphatemia is part of a true phosphate depletion syndrome (PDS). However, hypophosphatemia, even as low as 1.0–2.0 mg/dl in adults or 2.0–3.0 mg/dl in preadolescent children, does not necessarily mean or cause PDS. There are many examples in adult and child medicine of chronic hypophosphatemia caused by a high renal clearance of phosphorus (P) (low TmP/GFR) i.e. liberal amounts of P in the urine with low serum P. These do not develop a PDS unless there is superimposed a true lack of available P for the metabolic and growth needs of the patient. In the latter setting P excretion decreases markedly or disappears completely from the urine. This intense tubular reabsorption of P is an invariable feature of true phosphate depletion.
KeywordsDiabetic Ketoacidosis Phosphate Depletion Preadolescent Child Phosphorus Depletion Parenteral Hyperal Imentation
Unable to display preview. Download preview PDF.
- 1.A. Theiler, and H.H. Green, Aphosphorosis in ruminants. Nutr. Absts. and Rev. 1:359, (1932).Google Scholar
- 3.H. Copp and A.P. Suiker, Study of calcium kenetics in calcium and phosphorus deficient rats with the aid of radio calcium, in: Radio Isotope and Bone, P. Lacroix and A.M. Budy, eds., Blackwell Scientific Publications, Oxford, (1962).Google Scholar
- 6.Y. Yawata, Hebbel et al. Blood cell abnormalities complicating the hypophosphatemia of hyperalimentation: erythrocyte and platelet ATP deficiency associated with hemolytic anemia and bleeding in hyperalimented dogs. J. L and Clin Med. 84:643, (1975).Google Scholar
- 11.S.E. Silvis and P.D. Paragas, Jr. Parathesias, weakness, seizures, and hypophosphatemia in patients receiving hyperalimentation. Gastroent. 62:513, (1972).Google Scholar
- 13.J.R. Darsee and D.O. Nutter. Reversible severe congestive cardiomyopathy in three cases of hypophosphatemia. Ann. Int. Med. 86:867, (1978).Google Scholar
- 14.M. Lotz, R. Ney and F.C. Bartter. Osteomalacia and dibility resulting from phosphorus depletion. Trans of The Assoc. of Amer. Phys. 77:281, (1964).Google Scholar
- 15.D.B.N. Lee and C.R. Kleeman. Phosphorus depletion in man. Clinical Digest McGaw Laboratories 5: No. 3, (1975).Google Scholar
- 16.N. Brautbar, D.B.N. Lee and C.R. Kleeman, In Print, Divalent ions calcium, phosphorus and magnesium, and Vitamin D. In Contemporary Metabolism Vol. 2 Ed. N. Frienkel Plenum Publ Corp., N.Y.Google Scholar
- 17.U. Keller and W. Berger. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetis 29:87, (1980).Google Scholar