Effect of potassium depletion on response to acute heat exposure in unacclimatized man

Abstract

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Fever as a Cause of Hypophosphatemia in Patients with Malaria

“…Indeed, hypophosphatemia has been observed in every experimental or pathologic condition associated with an increase in body temperature in which serum phosphorus has been reported; in both animals [8] – [13] and in humans [4] – [6] , [14] – [29] . Hypophosphatemia has been reported in patients with fever from infection [bacteremia and sepsis [14] – [15] , bacterial pneumonia [16] , Legionnaire's disease [17] , toxic shock syndrome [18] , and malaria [4] – [6] ]; in patients with fever from non-infectious causes [trauma, post operative, burns, and pancreatitis [19] , drug fever [20] ]; in volunteers undergoing experimental hyperthermia [21] – [22] ; in patients receiving therapeutic hyperthermia [23] – [25] ; in patients with accidental hyperthermia (heat stroke) [26] ; during recovery from hypothermia [27] ; and in patients with neuroleptic malignant syndrome [28] and Reye's syndrome [29] . If the association between body temperature and serum phosphorus levels is causal, and not restricted to patients with malaria, then this would provide a unifying explanation for the hypophosphatemia seen in these otherwise unrelated conditions.…”

“…Acute respiratory alkalosis, by increasing intracellular pH, accelerating glycolysis, and causing phosphorus to shift from the extracellular to the intracellular compartment [30] , can result in transient hypophosphatemia in normal volunteers [7] . Because hyperventilation and acute respiratory alkalosis have been observed in sepsis [31] and in experimental [21] , [22] , [32] , therapeutic [23] , [24] and accidental hyperthermia (heat stroke) [25] , this mechanism has been proposed as an explanation for the hypophosphatemia observed in these conditions [1] – [3] . In our patients, however, pH and pCO2 were only minimally altered even in those with low serum phosphorus levels, and there were no correlations between serum phosphorus and respiratory rate, pH, or pCO2.…”