Maël Padelli1, Cyril Leven2, Mehdi Sakka2, Emmanuelle Plée-Gautier2, Jean-Luc Carré2. 1. University hospital of Brest, department of biochemistry and pharmaco-toxicology, 29200 Brest, France. Electronic address: mael.padelli@chu-brest.fr. 2. University hospital of Brest, department of biochemistry and pharmaco-toxicology, 29200 Brest, France.
Abstract
CONTEXT: Although hypophosphatemia is usually very seldom, it can reach two to 3% of hospitalized patients and until 28% of intensive care unit patients. Due to the lack of knowledge, clinical practice regarding seeking or treatment of hypophosphatemia is very heterogenous. However its clinical consequences might be heavy. A better knowledge of its causes, physiopathological effects and treatment should lead to a documented and homogenous care of these patients in clinics. OBJECTIVE: The aim of our study was a systematic review of littérature, seeking for publications about causes, consequences and treatment of hypophosphatemia. DOCUMENTARY SOURCES (KEYWORDS AND LANGUAGE): A research has been conducted on the Medline database by using the following keywords "phosphorus supplementation", "hypophosphatemia" and ("physiopathology" or "complications"). RESULTS: Three mains mechanisms might be responsible for hypophosphatemia: a decrease in digestive absorption, a rise in kidney excretion and a transfer of phosphorus to the intracellular compartment. Denutrition, acid base balance troubles, parenteral nutrition or several drugs are capable of provoking or favouring hypophosphatemia. All these situations are frequently encountered in intensive care unit. Consequences of hypophosphatemia might be serious. Best studied and documented are cardiac and respiratory muscle contractility decrease, sometimes leading to acute cardiac and respiratory failure, cardiac rhythm troubles and cardiac arrest. Hypophosphatemia is frequent during sepsis. It could be responsible for leucocyte dysfunction that might favour or increase sepsis. The treatment of hypophosphatemia is usually simple through a supplementation that quickly restores a regular concentration, with few adverse effects when regularly used. CONCLUSION: During at-risk situations, the systematic search for hypophosphatemia and its treatment may limit the occurrence of serious consequences.
CONTEXT: Although hypophosphatemia is usually very seldom, it can reach two to 3% of hospitalized patients and until 28% of intensive care unit patients. Due to the lack of knowledge, clinical practice regarding seeking or treatment of hypophosphatemia is very heterogenous. However its clinical consequences might be heavy. A better knowledge of its causes, physiopathological effects and treatment should lead to a documented and homogenous care of these patients in clinics. OBJECTIVE: The aim of our study was a systematic review of littérature, seeking for publications about causes, consequences and treatment of hypophosphatemia. DOCUMENTARY SOURCES (KEYWORDS AND LANGUAGE): A research has been conducted on the Medline database by using the following keywords "phosphorus supplementation", "hypophosphatemia" and ("physiopathology" or "complications"). RESULTS: Three mains mechanisms might be responsible for hypophosphatemia: a decrease in digestive absorption, a rise in kidney excretion and a transfer of phosphorus to the intracellular compartment. Denutrition, acid base balance troubles, parenteral nutrition or several drugs are capable of provoking or favouring hypophosphatemia. All these situations are frequently encountered in intensive care unit. Consequences of hypophosphatemia might be serious. Best studied and documented are cardiac and respiratory muscle contractility decrease, sometimes leading to acute cardiac and respiratory failure, cardiac rhythm troubles and cardiac arrest. Hypophosphatemia is frequent during sepsis. It could be responsible for leucocyte dysfunction that might favour or increase sepsis. The treatment of hypophosphatemia is usually simple through a supplementation that quickly restores a regular concentration, with few adverse effects when regularly used. CONCLUSION: During at-risk situations, the systematic search for hypophosphatemia and its treatment may limit the occurrence of serious consequences.
Authors: Melissa L Thompson Bastin; Arnold J Stromberg; Sethabhisha N Nerusu; Lucas J Liu; Kirby P Mayer; Kathleen D Liu; Sean M Bagshaw; Ron Wald; Peter E Morris; Javier A Neyra Journal: Clin J Am Soc Nephrol Date: 2022-04-27 Impact factor: 10.614