Severe hypophosphatemia: Pathophysiologic implications, clinical presentations, and treatment

Medicine

Volumn 79, Issue 1, 2000, Pages 1-8

  Subramanian, Rajesh ^a   Khardori, Romesh ^a  

^a SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; AMIODARONE; CALCITONIN; CALCIUM ACETATE; CAPTOPRIL; CHLORDIAZEPOXIDE; DEXTROPROPOXYPHENE; DIGOXIN; DOXEPIN; FERROUS SULFATE; INSULIN; LOOP DIURETIC AGENT; METOPROLOL; OMEPRAZOLE; PAMIDRONIC ACID; PHENYTOIN; PHOSPHATE; PROMETHAZINE; QUININE; THIAMINE; TRAZODONE; VALPROIC ACID;

ADULT; AGED; ARTICLE; CASE REPORT; CLINICAL FEATURE; DELIRIUM; DIAGNOSTIC PROCEDURE; DISEASE COURSE; FATIGUE; FEMALE; HUMAN; HYPOPHOSPHATEMIA; MALE; PARATHYROID ADENOMA; PATHOPHYSIOLOGY; PRIORITY JOURNAL; RHABDOMYOLYSIS; SEIZURE; TREATMENT OUTCOME;

ACUTE DISEASE; AGED; FEMALE; HUMANS; HYPOPHOSPHATEMIA; MALE; MIDDLE AGED; PHOSPHATES; PHOSPHORUS;

EID: 0033958001     PISSN: 00257974     EISSN: None     Source Type: Journal    
DOI: 10.1097/00005792-200001000-00001     Document Type: Article

References (103)

1. Abrams DE, Silcott RB, Terry R, Berne TV, Barbour BH. Antacid induction of phosphate depletion syndrome in renal failure. West J Med 120: 157-60, 1974.
2. Agusti AGN, Torres A, Estopa R, Agusti-Vidal A. Hypophosphatemia as a cause of failed weaning: The importance of metabolic factors. Crit Care Med 12: 142-43, 1984.
3. Angeli P, Gatta A, Caregaro L, Luisetto G, Menon F, Merkel C, Bolognesi M, Ruol A. Hypophosphatemia and renal tubular dysfunction in alcoholics. Gastroenterology 100: 502-12, 1991.
4. Aubier M, Murciano D, Lecocguic Y, Vires N, Jacquens Y, Squara P, Pariente R. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med 313: 420-24, 1985.
5. Bagdade JD, Nielson KL, Bulger RJ. Reversible abnormalities in phagocytic function in poorly controlled diabetic patients. Am J Med Sci 263: 451-56, 1972.
6. Bellorin-Font E, Milanes CL, Urbina D, Permalete N, Paz-Marinez V. The regulation of sodium phosphate cotransport in kidney. In: Puschett J, Greenberg A, eds. Diuretics. Vol II. London: Elsevier Science, pp 427-33, 1990.
7. Benesch R, Benesch RE. The effect of organic phosphates from the human erythrocyte on the allosteric properties of hemoglobin. Biochem Biophys Res Commun 26: 162-67, 1967.
8. Betro MG, Pain RW. Hypophosphataemia and hyperphosphataemia in a hospital population. Br Med J 1: 273-76, 1972.
9. Beutner EH, Munson PL. Time course of urinary excretion of inorganic phosphate by rats after parathyroidectomy and after injection of parathyroid extract. Endocrinology 66: 610-16, 1960.
10. Birmingham CL, Alothman AF, Goldner EM. Anorexia nervosa: Refeeding and hypophosphatemia. Int J Eat Disord 20: 211-13, 1996.
11. Bishop C, Williams CB. Diminished blood ATP levels induced in the chick by dietary aluminum hydroxide gel. Fed Proc 17: 15, 1958.
12. Blanchley JD, Ferguson ER, Carter NW, Knochel JP. Chronic alcohol ingestion induces phosphorus deficiency and myopathy in the dog. Trans Assoc Am Physicians 93: 110-22, 1980.
13. Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams textbook of endocrinology. 9th ed. Philadelphia: WB Saunders, pp 1155-1210, 1998.
14. Briscoe AM, Ragan C. Effect of magnesium on calcium metabolism in man. Am J Clin Nutr 19: 296-306, 1966.
15. Buell JF, Berger AC, Plotkin JS, Kuo PS, Johnson LB. The clinical implications of hypophosphatemia following major hepatic resection or cryosurgery. Arch Surg 133: 757-61, 1998.
16. Bunim JJ, Black RL, Lutwak L, Peterson RE, Whedon GD. Studies on dexamethasone, a new synthetic steroid, in rheumatoid arthritis - a preliminary report. Adrenal cortical, metabolic and early clinical effects. Arthritis Rheum 1: 313-31, 1958.
17. Camp MA, Allon M. Severe hypophosphatemia in hospitalized patients. Miner Electrolyte Metab 16: 365-68, 1990.
18. Chudley A, Ninan A, Young GB. Neurological signs and hypophosphatemia with total parenteral nutrition. Can Med Assoc J 125: 604-7, 1981.
19. Committee on Dietary Allowances, Food and Nutrition Board, National Research Council. Recommended daily allowances. 10th rev ed. Washington DC: National Academy Press, pp 184-87, 1989.
20. Cooke N, Teitelbaum S, Avioli LV. Antacid induced osteomalacia and nephrolithiasis. Arch Intern Med 138: 1007-9, 1978.
21. Craddock PR, Yawata Y, VanSanten L, Gilberstadt S, Silvis S, Jacob HS. Acquired phagocyte dysfunction: A complication of hypophosphatemia of parenteral hyperalimentation. N Engl J Med 290: 1403-7, 1974.
22. Cuisinier-Gleizes P, Thomasset M, Sainteny-Debove F, Mathieu H. Phosphorus deficiency, parathyroid hormone and bone resorption in the growing rat. Calcif Tissue Res 20: 235-49, 1976.
23. Danisi G, Murer H. Inorganic phosphate absorption in the small intestine. In: Field M, Frizzel RA, eds. Handbook of physiology. Sect 6, Vol 4. American Physiological Society: Bethesda, Maryland, pp 323-36, 1991.
24. DeFronzo RA, Lang R. Hypophosphatemia and glucose intolerance: Evidence for tissue insensitivity to insulin. N Engl J Med 303: 1259-63, 1980.
25. Ditzel J. Changes in red cell oxygen release capacity in diabetes mellitus. Fed Proc 38: 2484-88, 1979.
26. Drezner MK, Lobaugh LK. The pathogenesis and treatment of tumor-induced osteomalacia. In: Normal AW, Shalter K, Herath D, Grlgoleit HG, eds. Vitamin D: Chemical, biochemical and clinical endocrinology of calcium metabolism. Berlin: Walter de Gruyter, pp 945-54, 1982.
27. Ferguson ER, Blanchley JD, Carter NW, Knochel JP. Derangements of muscle composition, ion transport and oxygen consumption in chronically alcoholic dogs. Am J Physiol 246: F700-F709, 1984.
28. Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab 57: 177-80, 1983.
29. Fuller TJ, Carter NW, Barcenas C, Knochel JP. Reversible changes in muscle cell in experimental phosphorus deficiency. J Clin Invest 57: 1019-24, 1976.
30. Fuller TJ, Nichols WW, Brenner RJ, Peterson JC. Reversible depression in myocardial performance in dogs with experimental phosphorus deficiency. J Clin Invest 62: 1194-1200, 1978.
31. Garcia SA, Gonzalez-Calvin JL, Munoz-Torres M, Rios DS. Alcohol and renal phosphate excretion. Gastroenterology 102: 379, 1992.
32. Gentric A, Pennec YL. Fatal primary hyperparathyroidism with myopathy involving respiratory muscles in an old woman. J Am Geriatr Soc 42: 1306, 1994.
33. George R, Shiu MH. Hypophosphatemia after major hepatic resection. Surgery 111: 281-86, 1992.
34. Gertner JM, Lilburn M, Domenech M. 25-Hydroxycholecalciferol absorption in steatorrhea and postgastrectomy osteomalacia. Br Med J 1: 1310-1312, 1977.
35. Goldstein J, Vincent JL, Leclerc JL, Vanderhoeft P, Kahn RJ. Hypophosphatemia after cardiothoracic surgery. Intensive Care Med 11: 144-48, 1985.
36. Goodman M, Soloman CC, Miller PD. Distinction between the common symptoms of the phosphate-depletion syndrome and glucocorticoid-induced disease. Am J Med 65: 868-72, 1978.
37. Gorman MW, He MX, Hall CS, Sparks HV. Inorganic phosphate as regulator of adenosine formation in isolated guinea pig hearts. Am J Physiol 272: H913-H920, 1997.
38. Halevy J, Bulvik S. Severe hypophosphatemia in hospitalized patients. Arch Intern Med 148: 153-55, 1988.
39. Hoikka V, Alhava EM, Savolainen K, Karjalainen P, Parviainen M. The effect of partial gastrectomy on bone mineral metabolism. Scand J Gastroenterol 17: 257-61, 1982.
40. Hruska KA, Slatopolsky E. Disorders of phosphorus, calcium and magnesium metabolism. In: Schrier RW, Gottschalk CW, eds. Diseases of the kidney. 6th ed. Boston: Little, Brown, pp 2477-2526, 1996.
41. Jacob HS, Amsden T. Acute hemolytic anemia with rigid red cells in hypophosphatemia. N Engl J Med 285: 1446-50, 1971.
42. Juan D, Elrazak MA. Hypophosphatemia in hospitalized patients. JAMA 242: 163-64, 1979.
43. Knochel JP. Complications of total parenteral nutrition. Kidney Int 27: 489-96, 1985.
44. Knochel JP. Hypophosphatemia in the alcoholic. Arch Intern Med 140: 613-15, 1980.
45. Knochel JP. The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med 137: 203-20, 1977.
46. Knochel JP, Agarwal R. Hypophosphatemia and hyperphosphatemia. In: Brenner BM, ed. Brenner and Rector's the kidney. 5th ed. Philadelphia: WB Saunders, pp 1086-1133, 1996.
47. Knochel JP, Barcenas C, Cotton CR, Fuller TJ, Haller R. Hypophosphatemia and rhabdomyalysis. J Clin Invest 62: 1240-46, 1978.
48. Knochel JP, Bilbrey GL, Fuller TJ, Carter NW. The muscle cell in chronic alcoholism: The possible role of phosphate depletion in alcoholic myopathy. Ann N Y Acad Sci 252: 274-86, 1975.
49. Knox FG, Osswald H, Marchand GR, Spielman WS, Haas JA, Berndt T, Youngberg SP. Phosphate transport along the nephron. Am J Physiol 233: F261-F268, 1977.
50. Kohaut EC, Klish WJ, Beachler CW, Hill LL. Reduced renal acid excretion in malnutrition: A result of phosphate depletion. Am J Clin Nutr 30: 861-67, 1977.
51. Kohn MR, Golden NH, Shenker IR. Cardiac arrest and delirium: Presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa. J Adolesc Health 22: 239-43, 1998.
52. Krapf R, Vetsch R, Vetsch W, Hulter HN. Chronic metabolic acidosis increases the serum concentration of 1,25-dihydroxyvitamin D in humans by stimulating its production rate: Critical role of acidosis-induced renal hypophosphaturia. J Clin Invest 90: 2456-63, 1992.
53. Kristofferson A, Bjerle P, Stjernberg N, Jarhult J. Pre- and postoperative respiratory muscle strength in primary hyperparathyroidism. Acta Chir Scand 154: 415-18, 1988.
54. Laaban JP, Grateau G, Psychoyos I, Laromiguiere M, Vuong TK, Rochemaure J. Hypophosphatemia induced by mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 17: 1115-20, 1989.
55. Larsen VH, Waldau T, Gravesen H, Siggaard-Anderson O. Erythrocyte 2, 3 diphosphoglycerate depletion associated with hypophosphatemia detected by routine arterial blood gas analysis. Scand J Clin Lab Invest Suppl 224: 83-87, 1996.
56. Lennquist S, Lindell B, Nordstrom H, Sjoberg HE. Hypophosphatemia in severe bums. Acta Chir Scand 145: 1-6, 1979.
57. Lentz RD, Brown DM, Kjellstrand CM. Treatment of severe hypophosphatemia. Ann Intern Med 89: 941-44, 1978.
58. Lichtman MA, Miller DR, Cohen J, Waterhouse C. Reduced red cell glycolysis, 2, 3 diphosphoglycerate and adenosine triphosphate concentration, and increased hemoglobin-oxygen affinity caused by hypophosphatemia. Ann Intern Med 74: 562-68, 1971.
59. Lotz M, Zisman E, Bartter FC. Evidence for a phosphate-depletion syndrome in man. N Engl J Med 278: 409-15, 1968.
60. Machiels JP, Dive A, Donckier J, Installe E. Reversible myocardial dysfunction in a patient with alcoholic ketoacidosis. Am J Emerg Med 16: 371-73, 1998.
61. Maddock RJ, Moses JA Jr, Roth WT, King R, Murchison A, Berger PA. Serum phosphate and anxiety in major depression. Psychiatry Res 22: 29-36, 1987.
62. Mai ML, Emmett M, Sheikh MS, Santa Ana CA, Schiller L, Fordtran JS. Calcium acetate, an effective phosphorus binder in patients with renal failure. Kidney Int 36: 690-95, 1989.
63. Mostellar ME, Turtle EP Jr. Effects of alkalosis on plasma concentration and urinary excretion of inorganic phosphate in man. J Clin Invest 43: 138-49, 1964.
64. Murer H, Hildmann B. Transcellular transport of calcium and inorganic phosphate in the small intestinal epithelium. Am J Physiol 240: G409-16, 1981.
65. Murer H, Mareovich D, Bilber J. Renal and small intestine sodium dependent symporters of phosphate and sulphate. J Exp Biol 196:167-81, 1994.
66. Newman JH, Neff TA, Ziporin P. Acute respiratory failure associated with hypophosphatemia. N Engl Med 296: 1101-3, 1977.
67. O'Connor LR, Wheeler WS, Bethune JE. Effect of hypophosphatemia on myocardial performance in man. N Engl J Med 297: 901-3, 1977.
68. Ognibene A, Ciniglio R, Greifenstein A, Jarjoura D, Cugino A, Blend D, Whittier F. Ventricular tachycardia in acute myocardial infarction: The role of hypophosphatemia. South Med J 87: 65-69, 1994.
69. Okel BB, Hurst JW. Prolonged hyperventilation in man - associated electrolyte changes and subjective symptoms. Arch Intern Med 108: 757-62, 1961.
70. Pastoriza-Munoz E, Colindress RE, Lassiter WE, Lechene C. Effect of parathyroid hormone on phosphate reabsorption in rat distal convolution. Am J Physiol 235: F321-F330, 1978.
71. Paula FJ, Plens AE, Foss MC. Effects of hypophosphatemia on glucose tolerance and insulin secretion. Horm Metab Res 30: 281-84, 1998.
72. Pennington JAT, Young BE, Wilson DB. Nutritional elements in U.S. diets: Results from the Total Diet Study, 1982-86. J Am Diet Assoc 89: 659-64, 1989.
73. Peterlik M, Wasserman RH. Effect of vitamin D on transepithelial phosphate transport in chick intestine. Am J Physiol 234: E379-388, 1978.
74. Portale AA, Halloran BP, Morris RC Jr. Dietary intake of phosphate modulates the circadian rhythm in serum concentration of phosphorus: Implications for the renal production of 1,25-dihydroxyvitamin D. J Clin Invest 80: 1147-54, 1987.
75. Prins JG, Schrijver H, Staghouwer JH. Hyperalimentation, hypophosphatemia and coma. Lancet 1: 1253-54, 1973.
76. Pullman TN, Lavender AR, Impi A, Rasmussen H. Direct renal action of a purified parathyroid extract. Endocrinology 67: 570-82, 1960.
77. Ravid M, Robson M. Proximal myopathy caused by iatrogenic phosphate depletion. JAMA 236: 1380-81, 1976.
78. Riedler GF, Scheitlin WA. Hypophosphatemia in septicemia: Higher incidence in gram negative than in gram positive infections. Br Med J 1: 753-56, 1969.
79. Robertson JD. Calcium and phosphorus studies in myxoedema. Lancet 2:216-18, 1941.
80. Rosen GH, Boullata JI, O'Rangers EA, Enow NB, Shin B. Intravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemia. Crit Care Med 23: 1204-10, 1995.
81. Rosenburg M, McCarten JR, Synder BD, Tulloch JW. Case report: Hypophosphatemia with reversible ataxia and quadriparesis. Am J Med Sci 293: 261-64, 1987.
82. Ryback RS, Eckardt MJ, Pautler CP. Clinical relationships between serum phosphorus and other blood chemistry values in alcoholics. Arch Intern Med 140: 673-77, 1980.
83. Schiller LR, Santa Ana CA, Sheik MS, Emmett M, Fordtran JS. Effect of the time of administration of calcium acetate on phosphorus binding. N Engl J Med 320: 1110-13, 1989.
84. Sheikh MS, Maguire JA, Emmett M, Santa Ana CA, Nicar MJ, Schiller R, Fordtran JS. Reduction of dietary phosphorus absorption by phosphate binders: A theoretical, in vitro and in vivo study. J Clin Invest 83: 66-73, 1989.
85. Sheldon GF, Grzyb S. Phosphate depletion and repletion: Relation to parenteral nutrition and oxygen transport. Ann Surg 182: 683-89, 1975.
86. Shields HM. Rapid fall of serum phosphorus secondary to antacid therapy. Gastroenterology 75: 1137-41, 1978.
87. Siddiqui MF, Bertorini TE. Hypophosphatemia induced neuropathy: Clinical and electrophysiological findings. Muscle Nerve 21: 650-52, 1998.
88. Silvis SE, DiBartolomeo AG, Aaker HM. Hypophosphatemia and neurological changes secondary to oral caloric intake: A variant of the hyperalimentation syndrome. Am J Gastroenterol 73: 215-22, 1980.
89. Singhal PC, Kumar A, Desroaches L, Gibbons N, Mattana J. Prevalance and predictors of rhabdomyolysis in patients with hypophosphatemia. Am J Med 92: 458-64, 1992.
90. Solomon SM, Kirby DF. The refeeding syndrome: A review. JPEN J Parenter Enteral Nutr 14: 90-97, 1990.
91. Stein JH, Smith WO, Ginn HE. Hypophosphatemia in acute alcoholism. Am J Med Sci 252: 78-83, 1966.
92. Subramanian R, Khardori R. Hyperparathyroid crisis manifesting as repiratory and heart failure. Endocrine Practice (in press).
93. Suki WN. Phosphorus deficiency and hypophosphatemia. In: Bennett JC, Plum F, eds. Cecil textbook of medicine. 20th ed. Philadelphia: WB Saunders, pp 1135-37, 1996.
94. Travis SF, Sugarman HJ, Ruberg RL, Dudrick SJ, Delivoria-Papadopoulos M, Miller LD, Oski FA. Alterations of red-cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation. N Engl J Med 285: 763-68, 1971.
95. Treloar A, Crook M, Parker L, Doig R. Hypophosphatemia, hallucinations and delirium tremens. Lancet 338: 1467-68, 1991.
96. Vanneste J, Hage J. Acute severe hypophosphatemia mimicking Wernicke's encephalopathy. Lancet 1: 44, 1986.
97. Venditti FJ, Marotta C, Panezai FR, Oldewurtel HA, Regan TJ. Hypophosphatemia and cardiac arrhythmias. Miner Electrolyte Metab 13: 19-25, 1987.
98. Weinsier RL, Krumdieck CL. Death resulting from overzealous total parenteral nutrition: The refeeding syndrome revisited. Am J Clin Nutr 34: 393-99, 1981.
99. Wesson LG. Homeostasis of phosphate revisited. Nephron 77: 249-66, 1997.
100. Wiiddowson EM, McCance RA, Spray CM. The chemical composition of the human body. Clin Sci 10: 113-25, 1951.
101. Yatawa Y, Hebbel RP, Silvis S, Howe R, Jacob H. Blood cells abnormalities complicating the hypophosphatemia of hyperalimentation: Erythrocyte and platelet ATP deficiency associated with hemolytic anemia and bleeding in hyperalimented dogs. J Lab Clin Med 84: 643-53, 1974.
102. Youssef HA. Hypophosphatemic respiratory failure complicating total parenteral nutrition: A potentially lethal iatrogenic hazard. Int Surg 67: 371-72, 1982.
103. Zazzo JF, Troche G, Ruel P, Maintenant J. High incidence of hypophosphatemia in surgical intensive care patients: Efficacy of phosphorus therapy on myocardial function. Intensive Care Med 21: 826-31, 1995.