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Symptoms and Signs – Differential Diagnosis of Hypophosphataemia
Redistribution into cells
Increased insulin e.g. recovery from diabetic ketoacidosis (treatment with insulin stimulates glycolysis and phosphate uptake by the cells), refeeding (e.g. in alcoholics)
Respiratory alkalosis (alkalosis stimulates glycolysis and phosphate uptake by the cells)
Hungry bone syndrome (following parathyroidectomy in patients with preexisting osteopenia): due to marked deposition of Ca2+ and phosphate in bone
Gastrointestinal
Phosphate binders, e.g. aluminum/magnesium-containing antacids
Diarrhoea (chronic)
Reduced Dietary intake
Renal
Hyperparathyroidism (1° & 2°):increased urinary excretion
Vitamin D deficiency/resistance (both by reduced GI absorption and by causing
hypocalcaemia and 2° hyperparathyroidism)
Hereditary hypophosphataemic rickets (X-linked, autosomal dominant), tumourinduced
osteomalacia
Osmotic diuresis, e.g. glycosuria
Fanconi syndrome
Redistribution into cells
Increased insulin e.g. recovery from diabetic ketoacidosis (treatment with insulin stimulates glycolysis and phosphate uptake by the cells), refeeding (e.g. in alcoholics)
Respiratory alkalosis (alkalosis stimulates glycolysis and phosphate uptake by the cells)
Hungry bone syndrome (following parathyroidectomy in patients with preexisting osteopenia): due to marked deposition of Ca2+ and phosphate in bone
Gastrointestinal
Phosphate binders, e.g. aluminum/magnesium-containing antacids
Diarrhoea (chronic)
Reduced Dietary intake
Renal
Hyperparathyroidism (1° & 2°):increased urinary excretion
Vitamin D deficiency/resistance (both by reduced GI absorption and by causing
hypocalcaemia and 2° hyperparathyroidism)
Hereditary hypophosphataemic rickets (X-linked, autosomal dominant), tumourinduced
osteomalacia
Osmotic diuresis, e.g. glycosuria
Fanconi syndrome
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