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more about Hypophosphatemia

  • Hypophosphatemia is a technical way of saying that the Phosphorus level in the blood is too low.
  • Phosphorus, an essential component of bone, is a very important substance in maintaining proper body functioning.  Phosphorus is instrumental in storing and generating the energy that cells need to function normally.  The level of Phosphorus in the blood is maintained by various factors, including the kidneys, hormones such as parathyroid, and vitamin D.
  • Many conditions can cause or contribute to hypophosphatemia.  However, it is only rarely seen in the U.S. because the American diet is fairly abundant in phosphorous.
  • Symptoms of hypophosphatemia include muscle weakness or breakdown, anemia, confusion, Seizures, or heart failure.  If the Phosphorus level is extremely low, treatment will need to be started immediately.  Many treatments are available and will be discussed below.  However, the main treatment involves taking care of the underlying condition that is causing the low Phosphorus level.
  • Phosphorus is a substance that is found in meats, milk, whole grain breads, and cereals.  It is also found in fruits and vegetables, but only in small amounts. Phosphorus is very important in growth, energy formation, energy storage, nerve conduction, kidney function, and the formation of teeth and bones.  The recommended daily allowance for Phosphorus is similar to calcium.

  • Symptoms can include Muscle Cramps or weakness.  In some cases, Rhabdomyolysis (a condition in which muscle is broken down) may occur.  This is because oxygen and energy are not properly delivered to the muscles when the Phosphorus level is too low.
  • If hypophosphatemia has been present for a long time, it can cause muscle and bone pain, weak bones, and poor appetite.
  • If the Phosphorus level drops dramatically and suddenly, it can cause hemolysis (blood cells destruct), easy bleeding, and increased susceptibility to infections.
  • Rhabdomyolysis can also occur.
  • Mental changes can occur.  People may have confusion, Seizures, Coma, or problems with their speech.
  • Some may develop symptoms of heart failure.

  • Many factors may play a part in causing low Phosphorus levels.  Some of these include --
    1. Medications -- e.g., birth control pills, estrogen, anabolic steroids, aluminum hydroxide, theophylline, steroids, certain "water pills," and certain inhalers used by asthmatics
    2. Starvation or recovery from starvation
    3. Inadequate Phosphorus supplementation in those receiving TPN (total parenteral nutrition, i.e., nutritional feeding via channels other than the alimentary canal)
    4. Malabsorption syndromes
    5. Hypercalcemia
    6. Hypomagnesemia
    7. Hyperparathyroidism
    8. Vitamin D Deficiency or Vitamin D resistance
    9. Alcohol abuse
    10. Hyperthyroidism
    11. Poorly controlled diabetes or Diabetic Ketoacidosis
    12. Metabolic alkalosis
    13. Respiratory alkalosis
    14. Severe Burns
    15. Oncogenic Osteomalacia
    16. Hypokalemic nephropathy
    17. Salicylate poisoning
  • As stated, there are many diseases that can cause the Phosphorus level to be low.  The above is only a partial list.  The doctor will have to determine what may be causing the problem.

    • The symptoms for hypophosphatemia can be somewhat vague.  Therefore, the best method of diagnosis is by performing blood tests.
    • A blood test can be done to check the Phosphorus level.  It is simple and effective.  However, it does not reveal the amount of stored or "reserve" Phosphorus present.  This is important, as blood Phosphorus levels may be low, even though there may be plenty of stored Phosphorus -- an indication of a separate disease process that is interfering with the body's ability to use stored Phosphorus.  In other conditions, the body may have very low Phosphorus stores, but blood Phosphorus levels register high, normal, or low.  Ultimately, it is the phosphorous blood level that determines whether the symptoms of hypophosphatemia develop.
    • Other blood tests may show evidence of hemolytic anemia or Rhabdomyolysis, both of which can occur with low Phosphorus levels.
    • X-Rays may show thin, weak bones.
    • In hypophosphatemia, it is important to find out what is causing the problem in the first place.  Additional blood and urine tests should be discussed with the doctor.

    • There are no specific risk factors for hypophosphatemia.  However, having any of the conditions listed above can increase the risk.
    • Low Magnesium levels can also increase the risk.

    • If the Phosphorus level is only a little low, the condition can be treated more slowly.  In such cases, options for treatment include --
      1. Oral Phosphorus supplements
      2. Phosphorus supplementation from skimmed milk (an excellent source)
      3. Phosphorus supplements should be avoided if there is evidence of hypoparathyroidism, hypercalcemia, and kidney failure.  It should also be avoided in cases of tissue damage.
    • If the Phosphorus level is extremely low, it will require immediate treatment, such as those mentioned above.  However, these treatments take a while to work. Additional treatments have to be started, including --
      1. Administration of intravenous Phosphorus.  The amount that is necessary depends on the blood Phosphorus level.
      2. Calcium levels have to be watched carefully in anyone receiving intravenous Phosphorus because hypocalcemia can develop.
    • Patients on long-term intravenous nutrition need to be given supplemental Phosphorus.
    • In some cases, Magnesium deficiency can cause low Phosphorus levels.  Correcting the Magnesium deficiency will help correct the hypophosphatemia.
    • All of these measures only correct the Phosphorus levels temporarily.  The underlying process that caused the hypophosphatemia needs to be treated to avoid recurrence.  Only then will the treatment of hypophosphatemia be complete.

    • Hypophosphatemia can lead to muscle weakness and break down.
    • Anemia, if severe, can cause poor oxygenation of tissues, leading to kidney problems, Stroke, and heart attack.
    • Seizures and Coma are possible.
    • Heart failure, with all of its associated complications, can occur.
    • Some of the complications of hypophosphatemia will go away when the condition has been treated.

    • If the Phosphorus level is only slightly decreased, it may be possible to treat this condition as an outpatient.  If is it extremely low, then it needs to be treated more quickly.  Either way, the doctor will have to guide you in the best course of action.  However, it is very important that medical attention be obtained as soon as possible.

    • There is no specific way to prevent this condition.  However, proper nutrition and avoiding excess alcohol intake will help reduce the risk.

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