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The Pathophysiology and Clinical Characteristics of Severe Hypophosphatemia

The Pathophysiology and Clinical Characteristics of Severe Hypophosphatemia Abstract Hypophosphatemia, with or without phosphorus deficiency, is found commonly in patients with a variety of disease states. Severe hypophosphatemia is most often observed in chronic alcoholics, patients recovering from diabetic ketoacidosis, and those being therapeutically refed after severe weight loss. Its consequences may be severe and contribute to mortality. The following represents a selective review of available literature on this subject published over the past 50 years and a limited number of observations on patients and experimental animals. An attempt is made to examine mechanisms by which hypophosphatemia and phosphorus depletion probably occur, outline the resulting clinical disturbances, and suggest a plan of treatment. Finally, this review will hopefully point out areas of this interesting deficiency state that desperately need further investigation. (Arch Intern Med 137:203-220, 1977) References 1. Krebs H: Rate limiting factors in cell respiration . CIBA Foundation Symposium on Regulation of Cell Metabolism . Boston, Little Brown & Co, 1959, pp 1-10. 2. Pitts RF: Physiology of the Kidney and Body Fluids , ed 2. Chicago, Yearbook Publishers Inc, 1968. 3. Levenson SM, Adams MA, Rosen H, et al: Studies in phosphorus metabolism in man: III. The distribution, exchange and excretion of phosphorus in man using radioactive phosphorus (P-32) as a tracer . J Clin Invest 32:497-509, 1953.Crossref 4. Lotz M, Nay R, Bartter FC: Osteomalacia and debility resulting from phosphorus depletion . Trans Assoc Am Physicians 77:281-295, 1964. 5. Lotz M, Zisman E, Bartter FC: Evidence for a phosphorus depletion syndrome in man . N Engl J Med 278:409, 1968.Crossref 6. Coburn JW, Massry SG: Changes in serum and urinary calcium during phosphate depletion: Studies on mechanism . J Clin Invest 49:1073-1087, 1970.Crossref 7. Pronove P, Bell MH, Bartter FC: Production of hypercalciuria by phosphorus deprivation on a low calcium intake: A new clinical test for hyperparathyroidism . Metabolism 10:364-371, 1961. 8. Harrop GA Jr, Benedict EM: Role of phosphate and potassium in carbohydrate metabolism following insulin administration . Proc Soc Exp Biol Med 30:430, 1923.Crossref 9. Harrop GA Jr, Benedict EM: The participation of the inorganic substances in carbohydrate metabolism . J Biol Chem 59:683-697, 1924. 10. Groen J, Willebrands AF, Kamminga CE, et al: Effects of glucose administration on the potassium and inorganic phosphate content of the blood serum and the electrocardiogram in normal individuals and in nondiabetic patients . Acta Med Scand 141:352-366, 1952.Crossref 11. Gundersen K, Bradley RF, Marble A: Serum phosphorus and potassium levels after intravenous administration of glucose . N Engl J Med 250:547-554, 1954.Crossref 12. Kay HD, Robison R: Role of phosphates in carbohydrate metabolism: I. 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The Pathophysiology and Clinical Characteristics of Severe Hypophosphatemia

Archives of Internal Medicine , Volume 137 (2) – Feb 1, 1977

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Copyright © 1977 American Medical Association. All Rights Reserved.
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0003-9926
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10.1001/archinte.1977.03630140051013
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Abstract

Abstract Hypophosphatemia, with or without phosphorus deficiency, is found commonly in patients with a variety of disease states. Severe hypophosphatemia is most often observed in chronic alcoholics, patients recovering from diabetic ketoacidosis, and those being therapeutically refed after severe weight loss. Its consequences may be severe and contribute to mortality. The following represents a selective review of available literature on this subject published over the past 50 years and a limited number of observations on patients and experimental animals. An attempt is made to examine mechanisms by which hypophosphatemia and phosphorus depletion probably occur, outline the resulting clinical disturbances, and suggest a plan of treatment. Finally, this review will hopefully point out areas of this interesting deficiency state that desperately need further investigation. (Arch Intern Med 137:203-220, 1977) References 1. Krebs H: Rate limiting factors in cell respiration . CIBA Foundation Symposium on Regulation of Cell Metabolism . Boston, Little Brown & Co, 1959, pp 1-10. 2. Pitts RF: Physiology of the Kidney and Body Fluids , ed 2. Chicago, Yearbook Publishers Inc, 1968. 3. Levenson SM, Adams MA, Rosen H, et al: Studies in phosphorus metabolism in man: III. The distribution, exchange and excretion of phosphorus in man using radioactive phosphorus (P-32) as a tracer . J Clin Invest 32:497-509, 1953.Crossref 4. Lotz M, Nay R, Bartter FC: Osteomalacia and debility resulting from phosphorus depletion . Trans Assoc Am Physicians 77:281-295, 1964. 5. Lotz M, Zisman E, Bartter FC: Evidence for a phosphorus depletion syndrome in man . N Engl J Med 278:409, 1968.Crossref 6. Coburn JW, Massry SG: Changes in serum and urinary calcium during phosphate depletion: Studies on mechanism . J Clin Invest 49:1073-1087, 1970.Crossref 7. Pronove P, Bell MH, Bartter FC: Production of hypercalciuria by phosphorus deprivation on a low calcium intake: A new clinical test for hyperparathyroidism . Metabolism 10:364-371, 1961. 8. Harrop GA Jr, Benedict EM: Role of phosphate and potassium in carbohydrate metabolism following insulin administration . Proc Soc Exp Biol Med 30:430, 1923.Crossref 9. Harrop GA Jr, Benedict EM: The participation of the inorganic substances in carbohydrate metabolism . J Biol Chem 59:683-697, 1924. 10. Groen J, Willebrands AF, Kamminga CE, et al: Effects of glucose administration on the potassium and inorganic phosphate content of the blood serum and the electrocardiogram in normal individuals and in nondiabetic patients . Acta Med Scand 141:352-366, 1952.Crossref 11. Gundersen K, Bradley RF, Marble A: Serum phosphorus and potassium levels after intravenous administration of glucose . N Engl J Med 250:547-554, 1954.Crossref 12. Kay HD, Robison R: Role of phosphates in carbohydrate metabolism: I. 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Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1977

References