Meaning of this?
Low levels of phosphate in the blood
Normal Phosphate Levels?
2.7 - 4.5
Level for this?
< 2.7
Role of Phosphate in the body?
helps build bones/teeth and nerve/muscle function.
Stored mainly in the bones. The kidneys and parathyroid play a role in the regulation of calcium and phosphate.
Calcium and Phosphate?
For example, when calcium levels increase in turn phosphate levels decrease (vice versa).
Vitamin D and Phosphate
Vitamin D plays an important role in phosphate absorption.
Saying for Causes of Hypophosphatemia
Low “Phosphate”
“(P)hosphate”
Pharmacy: drugs such as aluminum hydroxide-based or magnesium based antacids cause malabsorption in the GI system, so no phosphate is absorbed through the GI track and the lack of vitamin d (which plays a role in phosphate absorption).
“P(h)osphate”
Hyperparathyroidism: due to over secretion of parathyroid hormone (parathyroid plays a role in maintaining calcium and phosphate levels and it normally inhibits re-absorption of phosphate by the kidneys). However, in hyperparathyroidism there is an over secretion of PTH which causes phosphate to NOT be reabsorbed at all.
“Ph(o)sphate”
Oncogenic osteomalacia: kidneys start to waste phosphate which leads to low phosphate levels and softening of the bones (this puts the patient at risk for bone fractures).
“Pho(s)phate”
Syndrome of Refeeding (aka Refeeding Syndrome): causes electrolytes and fluid problems due to malnutrition or starvation.
“Phos(p)hate”
Pulmonary issues such as respiratory alkalosis (under alkalotic conditions phosphate moves out of the blood into the cell which causes phosphate blood levels to decrease)
“Phosp(h)ate”
Hyperglycemia leads to symptoms of glycosuria, polyuria, ketoacidosis which causes the kidneys to waste phosphate
“Phosph(a)te”
Alcoholism: alcohol affects the body’s ability to absorb phosphate and many alcoholics are already malnourished (hence already have low phosphate level to begin with)
“Phospha(t)e”
Thermal Burns due to the shifting of phosphate intracellularly
“Phosphat(e)”
Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia also cause phosphate levels to decrease
Word for Signs and Symptoms of Hypophosphatemia
BROKEN
(B)roken
Breathing problems due to muscle weakness
B(r)oken
Rhabdomyolysis which is caused by an electrolyte disorder. This happens which there is rapid necrosis of the skeletal muscles which leads to renal failure. **These patients will have tea-colored looking urine due to myoglobin in the urine and will have muscle weakness/pain. The renal failure occurs because when the muscle dies, myoglobin is released into the blood which is very toxic to the kidneys. Reflexes (deep tendon) decreased
Br(o)ken
Osteomalacia (softening of the bones) fractures and decreased bone density (alteration in bone shape), cardiac Output decreased
Bro(k)en
Kills immune system with immune suppression and decreases platelet aggregation (which leads to increased bleeding)
Brok(e)n
Extreme weakness, Ecchymoses from decreased platelets
Broke(n)
Neuro status changes (irritability, confusion, seizures)
What signs and symptoms should we look for
These patients are at risk for broken bones and the systems of the body are breaking down (respiratory, muscles, neuro, immune etc.)
What should we administer?
**Administer oral phosphorus with Vitamin-D supplement (remember vitamin-d helps with absorbing phosphate)
If patient is receiving TPN
TPN watch for patient complaints of muscle pain or weakness (may be due to rhabdomyolysis or refeeding syndrome)
Safety due to
risk of bone fractures
Encourage foods that are
high is phosphate but low in calcium: **Foods high in phosphate are fish, organ meats, nuts, pork, beef, chicken, whole grains
What if Phosphate is less than 1?
the doctor may order IV phosphorous which affects calcium levels causing hypocalcemia or increase phosphate levels (Hyperphosphatemia). ***Also, assess renal status (BUN/creatintine normal) before administering phosphorous because if the kidneys are failing the patient won’t be able to clear phosphate). Place on cardiac monitor and watch for EKG changes.