hyperphosphatemia
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Etiology
- dehydration
- increased absorption from gut (up to 45 mg/dL)
- phosphate-containing IV solutions
- decreased renal excretion
- renal failure*
- hypoparathyroidism - increased renal tubular reabsorption[3]
- tumoral calcinosis
- pseudoxanthoma elasticum
- infantile hyperphosphatemia
- hyperostosis
- hyperthyroidism
- growth hormone excess/acromegaly
- adrenal insufficiency
- severe hypomagnesemia
- increased binding to serum proteins with plasma cell dyscrasias
- increased release from bone
- osteolytic metastases to bone
- healing fractures
- diabetes mellitus with ketosis
- cellular release of phosphate
- portal cirrhosis
- acid-base disorders
- metabolic acidosis including lactic acidosis
- acute respiratory acidosis
- drugs
* most common cause[3]
Laboratory
- serum Ca+2 & serum phosphorus
- product serum Ca+2 (mg/dL) x serum phosphorus (mg/dL) > 70 indicates risk of metastatic calcification
- metastatic calification more likely to occur with elevated pH
Complications
Management
- in the absence of renal insufficiency
- volume expansion with hypotonic saline
- aluminum-based antiacids (Amphogel)
- to prevent absorption of phosphorous
- more effective short term than PhosLo
- low risk of metastatic calcification
- low phosphate diet in patient with CKD4 & serum phosphate 5.3 mg/dL[3]
- most patients with renal failure require phosphate binders[3]
- must be taken with meals to bind phosphate in foods
- phosphate binders
- calcium acetate (PhosLo)
- non-calcium phosphate binders associate with lower mortality[6]
- hemodialysis as needed
More general terms
Additional terms
References
- ↑ Guide to Clinical Laboratory Tests, 3rd ed, NW Teitz (ed) WB Saunders, 1995
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2262
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
- ↑ Patel L, Bernard LM, Elder GJ. Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials. Clin J Am Soc Nephrol. 2016 Feb 5;11(2):232-44. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26668024 Free PMC Article
- ↑ 5.0 5.1 Kuznar W FDA Panel Endorses Kidney Disease Drug for Serum Phosphorus Control. Advisors see need for alternatives, citing suboptimal efficacy and tolerance of approved options. MedPage Today. November 17, 2022 https://www.medpagetoday.com/nephrology/generalnephrology/101802
- ↑ 6.0 6.1 NEJM Knowledge+ Nephrology/Urology