eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hypophosphatemia: Differential Diagnoses & Workup

Author: Devon J Moore, MD, Resident Physician, Department of Emergency Medicine, Wayne State University Detroit Medical Center, Detroit Receiving Hospital
Coauthor(s): Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Sep 22, 2009

Differential Diagnoses

Alcoholic Ketoacidosis
Anxiety
CBRNE - Botulism
Diabetic Ketoacidosis
Guillain-Barré Syndrome
Hyperventilation Syndrome

Other Problems to Be Considered

Refeeding syndrome

Workup

Laboratory Studies

  • Serum phosphate level
    • Serum phosphate or phosphorus normally ranges from 2.5-4.5 mg/dL in adults. Hypophosphatemia is defined as mild (2-2.5 mg/dL), moderate (1-2 mg/dL), or severe (<1 mg/dL).
    • Since the serum phosphate level may not accurately reflect the level of intracellular phosphate, always correlate serum phosphate levels with clinical findings, especially before embarking upon aggressive replacement therapy.
  • Abnormalities in serum magnesium, calcium, and potassium levels may occur.
    • Hypomagnesemia often is associated with the shift of phosphate into cells.
    • Hypercalcemia is common in primary hyperparathyroidism.
    • Derangements in serum potassium may occur with certain hypophosphatemia causes, such as DKA and alcoholism.

More on Hypophosphatemia

Overview: Hypophosphatemia
Differential Diagnoses & Workup: Hypophosphatemia
Treatment & Medication: Hypophosphatemia
Follow-up: Hypophosphatemia
References
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References

  1. Shaikh A, Berndt T, Kumar R. Regulation of phosphate homeostasis by the phosphatonins and other novel mediators. Pediatr Nephrol. Aug 2008;23(8):1203-10. [Medline].

  2. Datta BN, Stone MD. Hyperventilation and hypophosphataemia. Ann Clin Biochem. Mar 2009;46:170-1. [Medline].

  3. Mehanna H, Nankivell PC, Moledina J, Travis J. Refeeding syndrome - awareness, prevention and management. Head Neck Oncol. Jan 26 2009;1(1):4. [Medline].

  4. Nowik M, Picard N, Stange G, Capuano P, Tenenhouse HS, Biber J, et al. Renal phosphaturia during metabolic acidosis revisited: molecular mechanisms for decreased renal phosphate reabsorption. Pflugers Arch. Nov 2008;457(2):539-49. [Medline].

  5. Rastegar A. New concepts in pathogenesis of renal hypophosphatemic syndromes. Iran J Kidney Dis. Jan 2009;3(1):1-6. [Medline].

  6. Faroqui S, Levi M, Soleimani M, Amlal H. Estrogen downregulates the proximal tubule type IIa sodium phosphate cotransporter causing phosphate wasting and hypophosphatemia. Kidney Int. May 2008;73(10):1141-50. [Medline].

  7. Bates JA. Phosphorus: a quick reference. Vet Clin North Am Small Anim Pract. May 2008;38(3):471-5, viii. [Medline].

  8. Sebastian S, Clarence D, Newson C. Severe hypophosphataemia mimicking Guillain-Barré syndrome. Anaesthesia. Aug 2008;63(8):873-5. [Medline].

  9. Bastepe M, Juppner H. Inherited hypophosphatemic disorders in children and the evolving mechanisms of phosphate regulation. Rev Endocr Metab Disord. Jun 2008;9(2):171-80. [Medline].

  10. Crook MA. Management of severe hypophosphatemia. Nutrition. Mar 2009;25(3):368-9. [Medline].

  11. Domrongkitchaiporn S, Disthabanchong S, Cheawchanthanakij R, Niticharoenpong K, Stitchantrakul W, Charoenphandhu N, et al. Oral Phosphate Supplementation Corrects Hypophosphatemia and Normalizes Plasma FGF23 and 25-Hydroxyvitamin D3 Levels in Women with Chronic Metabolic Acidosis. Exp Clin Endocrinol Diabetes. May 15 2009;[Medline].

  12. Fukumoto S. Physiological regulation and disorders of phosphate metabolism--pivotal role of fibroblast growth factor 23. Intern Med. 2008;47(5):337-43. [Medline].

  13. Ghosh AK, Joshi SR. Disorders of calcium, phosphorus and magnesium metabolism. J Assoc Physicians India. Aug 2008;56:613-21. [Medline].

  14. Juppner H. Novel regulators of phosphate homeostasis and bone metabolism. Ther Apher Dial. Oct 2007;11 Suppl 1:S3-22. [Medline].

  15. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. Jun 2008;35(2):215-37, v-vi. [Medline].

  16. Oud L. Transient hypoxic respiratory failure in a patient with severe hypophosphatemia. Med Sci Monit. Mar 2009;15(3):CS49-53. [Medline].

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Further Reading

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Keywords

hypophosphatemia, hypophosphatemia symptoms, hypophosphatemia treatment, phosphate, low phosphate level, low phosphorus level, 2, 3-diphosphoglycerate, 2, 3-DPG, serum phosphate, phosphorus, refeeding syndrome

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Contributor Information and Disclosures

Author

Devon J Moore, MD, Resident Physician, Department of Emergency Medicine, Wayne State University Detroit Medical Center, Detroit Receiving Hospital
Devon J Moore, MD is a member of the following medical societies: American Medical Student Association/Foundation, Emergency Medicine Residents Association, and Wayne State School of Medicine Black Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard A Bessen, MD, Professor of Medicine, Department of Emergency Medicine, UCLA School of Medicine; Program Director, Harbor-UCLA Medical Center
Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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