Hypophosphatemia causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Refeeding syndrome This causes a demand for phosphate in cells due to the action of phosphofructokinase, an enzyme which attaches phosphate to glucose to begin metabolism of this. Also, production of ATP when cells are fed and recharge their energy supplies, requires phosphate.
• Respiratory alkalosis Any alkalemic condition moves phosphate out of the blood into cells. This includes most common respiratory alkalemia (a higher than normal blood pH from low carbon dioxide levels in the blood), which in turn is caused by any hyperventilation (such as sepsis, fever, pain, anxiety, drug withdrawal).
• Alcohol abuse Alcohol impairs phosphate absorption, and alcoholics are also after malnurished with regard to minerals. In addition, alcohol treatment is associated with refeeding, and the stress of alcohol withdrawal may create respiratory alkalosis, which exacerbates hypophosphatemia (see above).
• Malabsorption This includes GI damage, and also failure to absorb phosphate due to lack of vitamin D, or chronic use of phosphate binders such as sucralfate, aluminum-containing antacids, and (more rarely) calcium-containing antacids.
• Hyperexcretion of phosphate in the urine (phosphaturia). This includes excess excretion from renal dysfunction, and also the action of many classes of diuretics. Additionally, both primary and secondary hyperparathyroidism causes hyperexcretion of phosphate in the urine.

Other rarer causes include

• Certain blood cancers such as lymphoma or leukemia
• Hereditary causes
• Hepatic failure

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