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January 1988

Severe Hypophosphatemia in Hospitalized Patients

Author Affiliations

From the Department of Medicine E, Beilinson Medical Center, Petah Tiqva, and Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.

Arch Intern Med. 1988;148(1):153-155. doi:10.1001/archinte.1988.00380010155016

• Severe hypophosphatemia (serum phosphorus ≤0.48 mmol/L [≤1.5 mg/dL]) was found in 120 patients admitted to a major university hospital, during a period of 16 months. Fifty-one patients (42.5%) developed hypophosphatemia postoperatively. Medications known to precipitate hypophosphatemia were a causative factor in 82% of the patients, with glucose administered intravenously, antacids, diuretics, and steroids being the most common agents associated with profound hypophosphatemia. Gram-negative septicemia was observed in 16 patients, and it was the second most common cause of severe hypophosphatemia. The mortality rate was 20% in patients with a serum phosphorus concentration between 0.36 and 0.48 mmol/L (1.1 and 1.5 mg/dL) (group A) and 30% in patients with a serum phosphorus concentration of ≤0.32 mmol/L (1.0 mg/dL) (group B). The cause of death and its temporal association with the lowest observed values of phosphorus concentration indicate that severe hypophosphatemia might be a contributory factor to mortality. Our data indicate that severe hypophosphatemia in hospitalized patients is the result of a combination of factors. Surgery, followed by a period of fasting with intravenous administration of glucose, and gram-negative septicemia are the most common causes.

(Arch Intern Med 1988;148:153-155)