eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hypophosphatemia: Follow-up

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

Follow-up

Further Inpatient Care

  • Patients with severe or symptomatic hypophosphatemia should be admitted for IV replacement therapy.
  • Since isolated phosphate deficiency is extremely unlikely, these patients invariably have a comorbid reason for admission.
  • Equilibration of IV with intracellular phosphate usually leads to recurrence of hypophosphatemia, making periodic monitoring and replacement necessary over the ensuing 2 days.
  • A rational approach to IV phosphate replacement is to administer a predefined amount of phosphate, then reevaluate the resulting serum phosphate level every 6 hours to guide further treatment.

Complications

  • The ED physician should be aware of the complications of IV phosphate replacement, including hypocalcemia (tetany) and hyperphosphatemia.
  • Avoid hyperphosphatemia because it can cause crystal deposition in various tissues (eg, blood vessels, eye, lung, heart, kidney).
  • Always administer IV phosphate cautiously in patients with renal failure.

Patient Education

  • Patients and their families should be taught that 1 quart of cow's milk provides the amount of phosphate consumed by the average person in 1 day.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Thomas Mailhot, MD, and Alison J Richard, MD, to the development and writing of this article.



More on Hypophosphatemia

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

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  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].

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  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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