Hyperphosphatemia

HYPERPHOSPHATEMIA

• Hyperphosphatemia is defined as serum phosphate concentration >1.8 nmol/L (5.5mg/dL) results impaired glomerular infiltration, hypoparathyroidism, excess of phosphate into the ECF.

ETIOLOGY-

• Impaired renal phosphate excretion

1. Renal insufficiency
2. Hypoparathyroidism
3. Parathyroid suspension
4. Pseudohypoparathyroidism
5. Acromegaly

• Massive extracellular fluids phosphate loads

1. Necrosis
2. Transcellular phosphate shifts
3. Rapid administration of extracellular phosphate

 CLINICAL FEATURES

• Hypocalcaemia
• Metastatic calcification
• Nephrocalcinosis
• Acute severe hypophosphatemia- excessive urinary losses, severe malabsorption or malnutrition.
• Chronic hypophosphatemia affects musculoskeletal disorder as bone pain, osteomalacia, pseudofracture & weakness, encephalopathy.
• In children- rickets & short stature
• Neuromuscular manifestations- Confusion, disorientation, hallucinations, dysphagia, hyporeflexia, parathesia, Guillain- Barre, coma.
• Rhambdimyolysis

 INVESTIGATION

• Increased serum phosphate levels

 TREATMENT

• Normal saline
• Dietary phosphate restriction