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Hyperkalaemia Hypomagnesaemia Hypophosphataemia Hypernatraemia Hypokalaemia Hyponatraemia Hypocalcaemia Hypercalcaemia
Home | Articles | Electrolyte Disturbances | Hypophosphataemia

Hypophosphataemia

Last updated 13th March 2024

Content by Tina Grant

Introduction

  1. About 85% of body’s phosphorus is found in bone. The rest is stored intracellularly in tissues. It is therefore difficult to assess body stores from serum levels.
  2. Usual phosphorus intake is 30-50 mmol/day, mainly in dairy products
  3. Reference range for serum phosphate (adults) is 0.7-1.4mmol/l

Common Causes of Deficiency

  1. Inadequate intake – poor intake due to poor diet eg alcoholism, also parenteral nutrition if no PO4 added
  2. Increased renal excretion – eg primary hyperparathyroidism, vitamin D deficiency
  3. Transcellular shift – esp refeeding syndrome (link to refeeding syndrome) and also during treatment of DKA as insulin drives PO4 into cells
  4. Note that hypomagnesaemia and hypokalaemia often associated

Presentation

  1. Patients are usually only symptomatic when phosphate level reaches <0.3mmol//L
  2. When symptoms do occur then muscle weakness, bone pain, rhabdomyolysis, confusion and hallucinations are the most common presenting features
  3. Serum PO4 <0.3mmol/l is a medical emergency with risk of seizures, focal neurological deficits and heart failure, respiratory failure (due to weakness of the diaphragm), a proximal myopathy, dysphagia and ileus in addition to above

Mild Hypophosphataemia 0.6-0.69mmol/l

No treatment required

Moderate Hypophosphataemia 0.3-0.59mmol/l or symptomatic

  1. Give Phosphate-Sandoz 1-2 tablets orally tds (each tab contains 16mmol PO4, 3mmol K and 20mmol Na) and repeat phosphate the following day.
  2. Diarrhoea is a common side effect of oral phosphate therapy – risk can be reduced if given in at least 120ml of water
  3. Review dose daily according to phosphate levels and stop when serum PO4 >0.6mmol/l
  4. If nil by mouth, Rx sodium glycerophosphate 21.6% 20mmol (20ml) in 500ml glucose 5% over 12 hours IV. The 20ml solution contains 20mmol phosphate (1mmol/ml) and 40mmol sodium (2mmol/ml).

Severe Hypophosphataemia <0.3mmol/l

  1. Rx Sodium glycerophosphate 21.6%  40mmol given as 2 x 12 hour infusions IV, i.e. two infusions of 20mmol (20ml) in 500ml glucose 5% each over 12 hours.
  2. Reduce dose to 20mmol PO4 in 500ml glucose 5% over 12 hours if impaired renal function
  3. Monitor renal function, calcium, potassium and magnesium before and after PO4 infusion
  4. Repeat dose within 24 hours if serum phosphate remains below 0.6mmol/l
  5. Side effects of IV phosphate include hypocalcaemia due to binding with calcium and AKI due to Ca-PO4 precipitation in kidney.

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Content updated by Joanna Toohey & Chris Isles