1
Q
List the detrimental effects of hypophosphatemia
A
- Decreased erythrocyte ATP levels and increased RBC fragility (hemolysis)
- Decreased 2,3-BPG, which impairs oxygen delivery to tissues (shifts dissociation curve to the left)
- Impaired chemotaxis, phagocytosis, and bacterial killing of leukocytes
- Shortened platelet survival times
- Impaired clot retraction
- Thrombocytopenia
- Megakaryocytosis in bone marrow
- Muscle weakness
- Intestinal ileus (and vomiting, nausea, anorexia)
- Impaired CNS glucose use and ATP production (can lead to encephalopathy)
- Impaired cardiac contractility
- Increased renal tubular bicarb wasting
- Impaired renal ammoniagenesis
- Bone demineralization
2
Q
Why are diabetics more at risk for hypophosphatemia?
A
Total body deficits of phosphorus due to loss of muscle mass, urinary losses, and impaired cellular uptake due to insulin deficiency
3
Q
How does hypovitaminosis D cause systemic phosphorus deficit?
A
Decreased calcium absorption stimulates PTH, which causes decreased renal phosphorus reabsorption (increased renal phosphorus excretion)
4
Q
Is hypophosphatemia a negative or positive prognostic indicator in acute liver injury/failure?
A
Positive. It is thought hypophosphatemia may represent healing and regeneration of the liver (mechanism unknown).
5
Q
What are potential side effects of excessive IV phosphorus administration?
A
- Hypocalcemia
- Tetany
- Soft tissue mineralization
- Renal failure
- Hyperphosphatemia
DiBart 2021
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