• Respiratory alkalosis results in a shift of phosphorus from the extracellular to the intracellular compartment.
• The lowering of PCO2 due to respiratory alkalosis leads to intracellular acidosis, which stimulates phosphofructokinase activity, which in turn leads to increased glycolysis.
• The phosphorylated carbohydrate compounds generated as a result of the increase in intracellular glycolysis utilize inorganic phosphorus causing hypophosphatemia.
• Respiratory alkalosis-induced hypophosphatemia may cause rhabdomyolysis, especially in patients with alcohol use disorder. Hypophosphatemia may present with symptoms of muscle weakness and difficulty to wean in ventilated patients.