Hypophosphatemia Overview

Hypophosphatemia indicates a lack of phosphate in the blood. It is very rare in developed countries and never occurs in healthy people with a balanced diet. Hypophosphatemia almost always occurs as a result of serious illness or malnutrition.

What is hypophosphatemia?

Hypophosphatemia is a condition in which the concentration of phosphate in the blood has fallen below 0.8 millimoles per liter. As a result, there is a mineral metabolism disorder and a reduction in the energy supply in the cells. Under normal circumstances, such a drastic reduction in phosphate concentration is not possible. The reasons are almost always serious illnesses or malnutrition.

Hypophosphatemia often develops as an additional symptom of an underlying disease. In the case of malnutrition or malnutrition, it is one of several consequences. Hypophosphatemia is very rare in the general population. Healthy people never suffer from a phosphate deficiency. According to previous experience, it occurs in around three percent of hospital patients, up to 30 percent in alcoholics or up to 20 percent in chronic obstructive pulmonary diseases. Also, hypophosphatemia can occur in up to 80 percent of people with blood poisoning or serious injury.

Causes

Possible causes of hypophosphatemia include malnutrition, alcoholism, artificial nutrition without added phosphate, vitamin D deficiency, chronic obstructive pulmonary diseases or acid-binding drugs (antacids). Since the body has a high buffering capacity for phosphates, a phosphate deficiency is difficult to achieve. When the intake of phosphates is reduced, the bones serve as a source of phosphate.

In the process, they are increasingly broken down, which can lead to osteoporosis. Malnutrition of the body is mainly caused by anorexia nervosa (anorexia) in industrialized countries. In addition to other nutrients, phosphates are also missing here. Diseases that are associated with malabsorption of nutrients in the intestine can also lead to an undersupply of phosphates. These include diseases such as celiac disease or Krohn’s disease.

Since phosphates form a low pH value, acid-binding drugs also bind phosphates at the same time, which the body then loses. Chronic obstructive pulmonary disease leads to increased exhalation of carbonic acid (carbon dioxide). The increasing alkalinity in turn binds phosphates, so that this disease can also lead to phosphate deficiency. In the case of alcoholism, the body is no longer sufficiently supplied with nutrients and phosphates.

Hypophosphatemia can also result from an increased loss of phosphates. In the case of kidney diseases or urine-promoting medication, phosphates are flushed out of the body to a greater extent. Vitamin D deficiency or increased production of parathyroid hormone by the parathyroid gland also causes the loss of phosphates.

Symptoms, Ailments & Signs

Hypophosphatemia reduces energy production in the body’s cells. Phosphates are necessary for the formation of the important energy store ATP. If this can no longer be produced in sufficient concentration, the energy production also decreases. This lack of energy leads to fatigue, weakness and heart failure. Weight loss, nausea, and vomiting also occur. Cardiac arrhythmias and breathing difficulties are also frequently observed.

A phosphate deficiency can be without symptoms for a long time. In mild cases, the phosphate mobilized from the bone is sufficient to keep its concentration in the blood constant. The typical symptoms only appear in the event of a major phosphate deficiency. In the long term, the bones can become brittle due to the increased bone loss. Affected children suffer from bone deformities and short stature. This condition often occurs with vitamin D deficiency and is known as rickets.

Artificial nutrition as part of anorexia nervosa can lead to the so-called refeeding syndrome, which can often be life-threatening. The energy requirement of the body cells and at the same time the phosphate requirement rises sharply. The previous lack of phosphate intake leads to a dangerous hypophosphatemia and disturbance of the electrolyte balance with cardiac arrhythmias, edema, tremors and even heart failure. If the phosphate level falls below 0.3 mmol/l, hemolysis and destruction of muscle cells occurs.

Diagnosis & course of disease

If hypophosphatemia is suspected, it can be confirmed by a blood test for phosphates. Typical symptoms can confirm the suspected diagnosis of phosphate deficiency in the context of the anamnesis. The phosphate value should also be determined, especially in connection with malnutrition, malnutrition, malabsorption diseases of the intestine, COPD, alcoholism or kidney diseases.

Complications

In most cases, hypophosphatemia occurs when there is malnutrition or the patient is seriously ill. Consequently, the underlying disease must always be treated. This can also lead to various complications. However, the lack of phosphate also has a negative effect on the health of the patient.

This leads to a general feeling of illness and severe tiredness. The sufferer also suffers from heart problems and breathing difficulties. Sudden cardiac death or gasping can also occur. The patient’s life expectancy is greatly reduced by untreated hypophosphatemia. If hypophosphatemia occurs in children, it can lead to short stature or other disturbances in the physical and psychological development of the patient.

A failure can also occur in this case. Complications can occur if the phosphate is overdosed during treatment, in which case the kidneys in particular can be damaged. Patients who change their diet during treatment often have fewer complications to contend with. The symptoms then disappear within a few days.

When should you go to the doctor?

If fatigue, weakness and other typical symptoms of hypophosphatemia are noticed, medical advice is required. People who suddenly lose weight or experience recurring nausea and vomiting without an identifiable cause should also speak to their family doctor as soon as possible. In the case of serious complications such as cardiac arrhythmia or circulatory problems, it is best to consult a doctor on the same day. This is necessary above all if the feeling of illness increases rapidly in intensity or if there is a risk of falling.

In the event of serious circulatory problems, those affected should call the emergency doctor. Accompanying this, first-aid measures must be taken. The emergency services must also be alerted immediately in the event of heart failure or a circulatory collapse. Further treatment is provided by the general practitioner or an internist. Individuals suffering from malnutrition, alcohol addiction and other conditions that may cause phosphate deficiency are particularly prone to developing hypophosphatemia and should definitely seek medical attention if they experience these symptoms.

Treatment & Therapy

Treatment for hypophosphatemia depends on the underlying disease or disorder. In the case of a slight phosphate deficiency, it is sufficient to switch your diet to foods that are richer in phosphate. This is usually achieved by increasing the consumption of milk and milk products. In many cases, the phosphate deficiency is already compensated for in this way. In the case of larger phosphate deficits, sodium or potassium phosphate can also be administered.

Intensive care patients are often given intravenous solutions containing phosphate. However, care must be taken to ensure that phosphate is not overdosed. Overdosing can lead to kidney failure, hypocalcaemia, falling blood pressure and heart problems. However, it is very important to treat the underlying disease or to end the deficiency through a balanced diet.

Prevention

Hypophosphatemia can be prevented by eating a healthy and balanced diet. However, it should be noted that a phosphate deficiency can only be caused with great difficulty by a wrong lifestyle. The way of life has to be so extremely different that it is already considered a disease like anorexia nervosa or alcoholism. Here it is important to work through deeper-lying problems psychotherapeutically. Other causative diseases also require intensive treatment.

Aftercare

Depending on the severity of the hypophosphatemia, follow-up medication or a change in diet is required. A slight phosphate deficiency can be prevented by eating phosphate-rich foods, such as dairy products. For larger deficits, dietary supplements containing sodium phosphate or potassium phosphate are available.

By changing your diet, it is quite easy to avoid the previous problems. Those affected receive the relevant information from their doctor, pharmacist or professional nutritionist. It is important to ensure that the patients do not ingest too much phosphate.

Basically, it helps to have a balanced diet during aftercare. A good introspection is definitely useful. In this context, those affected should inform themselves comprehensively about the signs and causes of a phosphate deficiency. Sometimes there are psychological triggers for the disease that are more difficult to identify.

Such deeper-lying reasons can come to the surface, especially in the phase after the initial treatment. Psychotherapy may be recommended in order to successfully combat the physical symptoms through comprehensive aftercare. The corresponding work-up has a positive effect on the body feeling and on the overall quality of life of those affected.

You can do that yourself

The options for self-help are relatively severely limited when it comes to the symptoms of hypophosphatemia. However, if the disease occurs due to malnutrition, the diet must be changed. Fish and nuts are particularly suitable for eliminating the lack of phosphate.

In general, as soon as those affected are fed properly, there is rapid improvement and the deficiency can be remedied. Friends can also help with the creation of a nutrition plan, although in serious cases it is advisable to consult a nutritionist. The person concerned can also take dietary supplements from the pharmacy to counteract the deficiency. The consumption of dairy products also has a very positive effect on the course of the disease.

Furthermore, the person concerned should note that the amount of phosphate should not be exceeded. This is especially important when taking supplements. If in doubt, a doctor should always be consulted.

Since hypophosphatemia leads to heart problems and muscle weakness, the affected person should take it easy and not exercise or do any strenuous work. Talking to parents or friends often helps with serious eating disorders. However, it can also be useful to talk to other people affected.

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