HypophosphataemiaPathophysiology, effects and management on the intensive care unit

Bugg, N. C.; Jones, Jennifer

doi:10.1046/j.1365-2044.1998.00463.x

Cited by 105 publications

(139 citation statements)

References 52 publications

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“…8 In addition, hypophosphatemia of varying degrees has frequently been reported in association with sepsis and infection 9 and its timely recognition and treatment is of considerable importance in intensive care units. 10 In the absence of the recognized causes of hypophosphatemia including inadequate intake and loss of phosphate from the body, incorporation of inorganic phosphate by rapidly proliferating cells could significantly contribute to hypophosphatemia in hematological malignancies. 3 Resulting severe hypophosphatemia could, in turn, negatively affect the cellular formation of phosphate-containing compounds including adenosine triphosphate and 2,3-diphosphoglycerate necessary to maintain normal homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Severe hypophosphatemia during hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation

Steiner

Wilhelm

et al. 2000

Bone Marrow Transplant

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Summary:A patient suffering from acute myeloid leukemia (FAB M5a) received a PBSC allograft from a matched, related donor. On day 13 after transplantation severe hypophosphatemia (0.21 mmol/l) was first noted which persisted irrespective of intravenous phosphate administration, and within 2 days reached concentrations below 0.13 mmol/l. After repeated phosphate substitution serum phosphate returned to 1.40 mmol/l on day 17. Phosphate in urine, and calcium in serum were recorded as unchanged throughout. Clinical signs and symptoms due to severe hypophosphatemia were not observed except for paresthesia in the lower extremities. The precipitous fall in serum phosphate coincided with hematopoietic reconstitution as reflected by a steep rise in leukocyte count from 0.08 × 10 9 /l on day 10 to 5.94 × 10 9 /l on day 15 after transplantation. Thus, isolated hypophosphatemia was likely the result of excessive cellular phosphate uptake during hematopoietic reconstitution. Electrolyte monitoring after PBSCT should include serum phosphate to identify the hypophosphatemia associated with hematopoietic recovery. Bone Marrow Transplantation (2000) 25, 1015-1016. Keywords: hypophosphatemia; hematopoietic reconstitution; allogeneic PBSCT The reference range for inorganic serum phosphate is 0.80-1.30 mmol/l. Mild to moderate hypophosphatemia arbitrarily defined as 0.30-0.80 mmol/l is a frequently encountered laboratory finding in hospitalized patients, whereas severe hypophosphatemia quoted as a serum concentration below 0.30 mmol/l must be considered a rare but potentially life-threatening condition. 1 Severe hypophosphatemia leads to a wide range of clinical manifestations including cardiovascular, respiratory, neuromuscular, and hematological effects. Intravenous phosphate replacement may be required in these cases to correct the concentration of serum phosphate, thus ameliorating the risk of complications. 2 Although usually multifactorial in origin, the pathogenesis of hypophosphatemia includes the following mechanisms: inadequate phosphate intake, decreased intestinal absorption, gastrointestinal or renal phosphate loss, and redistribution of phosphate into cells. The latter mechanism might be the link between rapidly proliferating cells and severe hypophosphatemia as has been reported in patients suffering from hematological malignancies. 3,4 Similarly, low serum phosphate concentrations have been reported in patients undergoing stem cell harvesting 5 or bone marrow/ peripheral blood stem cell transplantation. 6,7 Case reportA 38-year-old male patient was diagnosed in December 1998 with acute myeloid leukemia FAB M5a. He was treated with courses of cytarabine, idarubicin/cytarabine, and mitoxantrone/cytarabine, and conditioning for stem cell transplantation including total body irradiation, VP16 and cyclophosphamide. 2.97 × 10 6 /kg body weight CD34 + peripheral blood stem cells from an HLA-identical related donor were given. Therapy-associated complications included mucositis (WHO grade IV), local skin toxicity after radi...

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Section: Discussionmentioning

confidence: 99%

Severe hypophosphatemia during hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation

Steiner

Wilhelm

et al. 2000

Bone Marrow Transplant

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“…A high APACHE and TISS scores, older age, male gender and TPN were found to be independent predictor factors for in-ICU and hospital mortality in this critically ill population. Hypophosphatemia is a frequent electrolyte disturbance in critically ill patients, including the septic population [4,11,12]. Gram-negative bacteremia in particular is strongly associated with hypophosphatemia [13].…”

Section: Discussionmentioning

confidence: 99%

“…Hypophosphatemia has been reported as one of the early findings of severe sepsis/septic shock [4,5]. Moreover, it has been recognized as an independent risk factor for the development of cardiac arrhythmias and a high mortality rate in septic patients.…”

mentioning

confidence: 99%

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

Brotfain¹,

Schwartz²,

Boniel³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis Methods: We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients' ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay. Results: The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 -early hypophosphatemia; group 2 -early hypophosphatemia and thrombocytopenia and group 3 -early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II score > 27, a TISS score > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population. Conclusion: It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

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“…The functions of phosphate in the body have been outlined in a recent review [69]. The main function is to store and release energy via compounds such as ATP that contain high-energy phosphate bonds.…”

Section: Phosphatementioning

confidence: 99%

“…Causes of hypophosphataemia [69,72] 1 Decreased intake and/or absorption: malnutrition, aluminium antacids.…”

Section: Regulation Of Phosphate In the Ecfmentioning

confidence: 99%

Anions and the anaesthetist

2002

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SummaryAnions are the negative components of most chemical structures and play many important physiological and pharmacological roles that are of interest to the anaesthetist. Their relevance is reviewed with a particular emphasis on the inorganic anions (halides, bicarbonate, phosphate and sulphate) and the significance and limitations of the anion gap. Organic anions (albumin, lactate) are also discussed, albeit briefly. The suitability of anions for their role in neurotransmission and acid2base balance is outlined.

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HypophosphataemiaPathophysiology, effects and management on the intensive care unit

Cited by 105 publications

References 52 publications

Severe hypophosphatemia during hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation

Severe hypophosphatemia during hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

Anions and the anaesthetist

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