Medication Summary

Treatment depends on the symptoms and severity of the condition.

Class Summary

These agents are used to increase serum phosphorus to normal physiologic levels.

Potassium phosphate/sodium acid phosphate

View full drug information

IV preparations are available as sodium phosphate (Na₂ HPO₄ and NAH₂ PO₄) or potassium phosphate (K₂ HPO₄ and KH₂ PO₄).

Response to IV phosphorus supplementation varies widely and may be associated with hyperphosphatemia and hypocalcemia. Rate of infusion and choice of initial dosage should be based on severity of hypophosphatemia and presence of symptoms.

When treating hypophosphatemia with potassium phosphate, potassium level may limit amount of phosphate that can be given safely.

One Canadian group recently reported administering 30 mmol of potassium phosphate via central line over 3 h for severe hypophosphatemia and 15 mmol of potassium phosphate via central line over 3 h for moderate hypophosphatemia.

Another study reported safely administering IV phosphate at a rate of 14.5 mmol of phosphate ions over 1 h.

Follow-up

Tejeda A, Saffarian N, Uday K, Dave M. Hypophosphatemia in end stage renal disease. Nephron. 1996. 73(4):674-8. [QxMD MEDLINE Link].
Camp MA, Allon M. Severe hypophosphatemia in hospitalized patients. Miner Electrolyte Metab. 1990. 16(6):365-8. [QxMD MEDLINE Link].
Liamis G, Milionis HJ, Elisaf M. Medication-induced hypophosphatemia: a review. QJM. 2010 Jul. 103(7):449-59. [QxMD MEDLINE Link].
Shaikh A, Berndt T, Kumar R. Regulation of phosphate homeostasis by the phosphatonins and other novel mediators. Pediatr Nephrol. 2008 Aug. 23(8):1203-10. [QxMD MEDLINE Link]. [Full Text].
Brautbar N, Leibovici H, Massry SG. On the mechanism of hypophosphatemia during acute hyperventilation: evidence for increased muscle glycolysis. Miner Electrolyte Metab. 1983 Jan-Feb. 9(1):45-50. [QxMD MEDLINE Link].
Datta BN, Stone MD. Hyperventilation and hypophosphataemia. Ann Clin Biochem. 2009 Mar. 46:170-1. [QxMD MEDLINE Link].
Becker S, Dam G, Hvas CL. Refeeding encephalopathy in a patient with severe hypophosphataemia and hyperammonaemia. Eur J Clin Nutr. 2014 Nov 12. [QxMD MEDLINE Link].
Mehanna H, Nankivell PC, Moledina J, Travis J. Refeeding syndrome - awareness, prevention and management. Head Neck Oncol. 2009 Jan 26. 1(1):4. [QxMD MEDLINE Link].
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. 2008 Nov. 457(2):539-49. [QxMD MEDLINE Link].
Bodenhamer J, Bergstrom R, Brown D, Gabow P, Marx JA, Lowenstein SR. Frequently nebulized beta-agonists for asthma: effects on serum electrolytes. Ann Emerg Med. 1992 Nov. 21(11):1337-42. [QxMD MEDLINE Link].
Tenenhouse HS. Phosphate transport: molecular basis, regulation and pathophysiology. J Steroid Biochem Mol Biol. 2007 Mar. 103(3-5):572-7. [QxMD MEDLINE Link].
Hu CY, Lee BJ, Cheng HF, Wang CY. Acetazolamide-related Life-threatening Hypophosphatemia in a Glaucoma Patient. J Glaucoma. 2014 Oct 20. [QxMD MEDLINE Link].
Rastegar A. New concepts in pathogenesis of renal hypophosphatemic syndromes. Iran J Kidney Dis. 2009 Jan. 3(1):1-6. [QxMD MEDLINE Link].
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. 2008 May. 73(10):1141-50. [QxMD MEDLINE Link].
Bates JA. Phosphorus: a quick reference. Vet Clin North Am Small Anim Pract. 2008 May. 38(3):471-5, viii. [QxMD MEDLINE Link].
Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand. 2011 Jan. 55 (1):39-45. [QxMD MEDLINE Link].
King AL, Sica DA, Miller G, Pierpaoli S. Severe hypophosphatemia in a general hospital population. South Med J. 1987 Jul. 80(7):831-5. [QxMD MEDLINE Link].
Travis SF, Sugerman HJ, Ruberg RL, Dudrick SJ, Delivoria-Papadopoulos M, Miller LD, et al. Alterations of red-cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation. N Engl J Med. 1971 Sep 30. 285(14):763-8. [QxMD MEDLINE Link].
Knochel JP. The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med. 1977 Feb. 137 (2):203-20. [QxMD MEDLINE Link].
Weisinger JR, Bellorín-Font E. Magnesium and phosphorus. Lancet. 1998 Aug 1. 352 (9125):391-6. [QxMD MEDLINE Link].
Knochel JP. Hypophosphatemia and rhabdomyolysis. Am J Med. 1992 May. 92(5):455-7. [QxMD MEDLINE Link].
Aubier M, Murciano D, Lecocguic Y, Viires N, Jacquens Y, Squara P, et al. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med. 1985 Aug 15. 313 (7):420-4. [QxMD MEDLINE Link].
Cohen J, Kogan A, Sahar G, Lev S, Vidne B, Singer P. Hypophosphatemia following open heart surgery: incidence and consequences. Eur J Cardiothorac Surg. 2004 Aug. 26 (2):306-10. [QxMD MEDLINE Link].
Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelman M. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci. 2010 Spring. 40 (2):144-8. [QxMD MEDLINE Link].
Davis SV, Olichwier KK, Chakko SC. Reversible depression of myocardial performance in hypophosphatemia. Am J Med Sci. 1988 Mar. 295(3):183-7. [QxMD MEDLINE Link].
Sebastian S, Clarence D, Newson C. Severe hypophosphataemia mimicking Guillain-Barré syndrome. Anaesthesia. 2008 Aug. 63(8):873-5. [QxMD MEDLINE Link].
Larsson L, Rebel K, Sörbo B. Severe hypophosphatemia--a hospital survey. Acta Med Scand. 1983. 214 (3):221-3. [QxMD MEDLINE Link].
King AL, Sica DA, Miller G, Pierpaoli S. Severe hypophosphatemia in a general hospital population. South Med J. 1987 Jul. 80 (7):831-5. [QxMD MEDLINE Link].
Gaasbeek A, Meinders AE. Hypophosphatemia: an update on its etiology and treatment. Am J Med. 2005 Oct. 118 (10):1094-101. [QxMD MEDLINE Link].
Adhikari S, Mamlouk O, Rondon-Berrios H, Workeneh BT. Hypophosphatemia in cancer patients. Clin Kidney J. 2021 Nov. 14 (11):2304-15. [QxMD MEDLINE Link]. [Full Text].
Biber J, Hernando N, Forster I. Phosphate transporters and their function. Annu Rev Physiol. 2013. 75:535-50. [QxMD MEDLINE Link].
Taylor BE, Huey WY, Buchman TG, Boyle WA, Coopersmith CM. Treatment of hypophosphatemia using a protocol based on patient weight and serum phosphorus level in a surgical intensive care unit. J Am Coll Surg. 2004 Feb. 198(2):198-204. [QxMD MEDLINE Link].
Prié D, Blanchet FB, Essig M, Jourdain JP, Friedlander G. Dipyridamole decreases renal phosphate leak and augments serum phosphorus in patients with low renal phosphate threshold. J Am Soc Nephrol. 1998 Jul. 9 (7):1264-9. [QxMD MEDLINE Link].

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Alex Koyfman, MD Assistant Professor, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Parkland Memorial Hospital

Alex Koyfman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Brit J Long, MD Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Staff Physician, Department of Emergency Medicine, Associate Program Director - Research, San Antonio Uniformed Services Health Education Consortium

Brit J Long, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen 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.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luda Khait, MD, MS Resident Physician, Department of Emergency Medicine, Detroit Medical Center, Detroit Receiving Hospital

Luda Khait, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Michigan State Medical Society, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Acknowledgements

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.