Hypophosphatemia NCLEX Review Notes

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February 12, 2016

Hypo: “below”

Phosphat: prefix for phosphate

Emia: blood

Meaning of Hypophosphatemia: Low levels of phosphate in the blood

Normal Phosphate levels: 2.7 to 4.5 mg/dL (<2.7 is hypophosphatemia)

Role of phosphate in the body: helps build bones/teeth and nerve/muscle function.

Stored mainly in the bones. The kidneys and parathyroid play a role in the regulation of
calcium and phosphate.

**Calcium and phosphate influence each other in opposite way. For example, when
calcium levels increase in turn phosphate levels decrease (vice versa).

Vitamin D plays an important role in phosphate absorption.

Causes of Hypophosphatemia
Remember phrase: Low “Phosphate”

Pharmacy: drugs such as aluminum hydroxide-based or magnesium based antacids cause

malabsorption in the GI system, so no phosphate is absorbed through the GI track and the
lack of vitamin d (which plays a role in phosphate absorption).

Hyperparathyroidism: due to over secretion of parathyroid hormone (parathyroid plays a

role in maintaining calcium and phosphate levels and it normally inhibits re-absorption of
phosphate by the kidneys). However, in hyperparathyroidism there is an over secretion of
PTH which causes phosphate to NOT be reabsorbed at all.

Oncogenic osteomalacia: kidneys start to waste phosphate which leads to low phosphate
levels and softening of the bones (this puts the patient at risk for bone fractures).

Syndrome of Refeeding (aka Refeeding Syndrome): causes electrolytes and fluid

problems due to malnutrition or starvation.

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**Watch patients who are on TPN (total parenteral nutrition). This happens when food is
reintroduced after the body being in starvation mode (hence the body went into survival
mode and is depleted of almost everything). When the nutrition is introduced, the body
releases insulin due to the increased blood sugar from the food which causes the body to
rapidly use the already low stores of phosphate, magnesium, and potassium to help with
synthesizing. This depletes phosphate levels.

Pulmonary issues such as respiratory alkalosis (under alkalotic conditions phosphate moves
out of the blood into the cell which causes phosphate blood levels to decrease)

Hyperglycemia leads to symptoms of glycosuria, polyuria, ketoacidosis which causes the

kidneys to waste phosphate

Alcoholism: alcohol affects the body’s ability to absorb phosphate and many alcoholics are
already malnourished (hence already have low phosphate level to begin with)

Thermal Burns due to the shifting of phosphate intracellularly

Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia also cause phosphate

levels to decrease

Signs & Symptoms of Hypophosphatemia

Remember the word: “BROKEN”

These patients are at risk for broken bones and the systems of the body are breaking down
(respiratory, muscles, neuro, immune etc.)

Breathing problems due to muscle weakness

Rhabdomyolysis which is caused by an electrolyte disorder. This happens when there is rapid
necrosis of the skeletal muscles which leads to renal failure. **These patients will have tea-
colored looking urine due to myoglobin in the urine and will have muscle weakness/pain.
The renal failure occurs because when the muscle dies, myoglobin is released into the blood
which is very toxic to the kidneys. Reflexes (deep tendon) decreased

Osteomalacia (softening of the bones) fractures and decreased bone density (alteration in
bone shape), cardiac Output decreased

Kills immune system with immune suppression and decreases platelet aggregation (which
leads to increased bleeding)

Extreme weakness, Ecchymosis from decreased platelets

Neuro status changes (irritability, confusion, seizures)

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Nursing Interventions for Hypophosphatemia
**Administer oral phosphorus with Vitamin-D supplement (remember vitamin-d helps
with absorbing phosphate)

If patient is receiving TPN watch for patient complaints of muscle pain or weakness (may be
due to rhabdomyolysis or refeeding syndrome)

Ensure patient safety due to risk of bone fractures

Encourage foods high is phosphate but low in calcium: **Foods high in phosphate are
fish, organ meats, nuts, pork, beef, chicken, whole grains

If phosphate levels less than 1mg/dL, the doctor may order IV phosphorous which
affects calcium levels causing hypocalcemia or increase phosphate levels
(Hyperphosphatemia). ***Also, assess renal status (BUN/creatintine normal) before
administering phosphorous because if the kidneys are failing the patient won’t be able to
clear phosphate). Place on cardiac monitor and watch for EKG changes.

Quiz on Hypophosphatemia & Hyperphosphatemia

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