Skip to main content
SpringerLink
Log in

Hypophosphatemia

  • Chapter
  • First Online:
Endocrine Conditions in Pediatrics

  • 1173 Accesses

Abstract

Hypophosphatemia is defined as a serum phosphorus level below the age-appropriate normal range. Acute hypophosphatemia is most commonly seen in the setting of a critical illness, whereas chronic hypophosphatemia is more likely to be of endocrine origin. The most common endocrine etiologies of chronic hypophosphatemia include vitamin D deficiency, hyperparathyroidism, and inherited forms of hypophosphatemic rickets mediated by excess fibroblast growth factor 23. Phosphate homeostasis, mechanisms of hypophosphatemia, and pertinent aspects of evaluation and management are discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Amanzadeh J, Reilly RF Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol. 2006;2(3):136–48.

    Article  CAS  PubMed  Google Scholar 

  2. Sharma S, Hashmi MF, Castro D. Hypophosphatemia. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; 2019.

    Google Scholar 

  3. Kleinman K, McDaniel L, Molloy M, editors. The Harriet Lane Handbook: The Johns Hopkins Hospital, 22nd Edition. Elsevier; 2020. p. 974.

    Google Scholar 

  4. Takeda E, Taketani Y, Sawada N, Sato T, Yamamoto H. The regulation and function of phosphate in the human body. BioFactors (Oxford, England). 2004;21(1–4):345–55.

    Article  CAS  Google Scholar 

  5. Bergwitz C, Juppner H. Phosphate sensing. Adv Chronic Kidney Dis. 2011;18(2):132–44.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Blaine J, Chonchol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol. 2015;10(7):1257–72.

    Article  CAS  PubMed  Google Scholar 

  7. White KE, Larsson TE, Econs MJ. The roles of specific genes implicated as circulating factors involved in normal and disordered phosphate homeostasis: frizzled related protein-4, matrix extracellular phosphoglycoprotein, and fibroblast growth factor 23. Endocr Rev. 2006;27(3):221–41.

    Article  CAS  PubMed  Google Scholar 

  8. Clinkenbeard EL, White KE. Systemic control of bone homeostasis by FGF23 signaling. Curr Mol Biol Rep. 2016;2(1):62–71.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kurnik BR, Hruska KA. Mechanism of stimulation of renal phosphate transport by 1,25-dihydroxycholecalciferol. Biochim Biophys Acta. 1985;817(1):42–50.

    Article  CAS  PubMed  Google Scholar 

  10. Root AW, FBDJ MD. Disorders of mineral homeostasis in children and adolescents. In: Sperling MA, editor. Pediatric endocrinology. 4th ed. Philadelphia, PA: Elsevier; 2014. p. 734–845.

    Chapter  Google Scholar 

  11. Creo AL, Epp LM, Buchholtz JA, Tebben PJ. Prevalence of metabolic bone disease in tube-fed children receiving elemental formula. Horm Res Paediatr. 2018;90(5):291–8.

    Article  CAS  PubMed  Google Scholar 

  12. Leitner M, Burstein B, Agostino H. Prophylactic phosphate supplementation for the inpatient treatment of restrictive eating disorders. J Adolesc Health. 2016;58(6):616–20.

    Article  PubMed  Google Scholar 

  13. Bustos Lozano G, Hidalgo Romero A, Melgar Bonis A, Ureta Velasco N, Orbea Gallardo C, Pallas Alonso C. [Early hypophosphataemia in at risk newborns. Frequency and magnitude]. Anales De Pediatria (Barcelona, Spain : 2003). 2018;88(4):216–22.

    Google Scholar 

  14. Lotz M, Zisman E, Bartter FC. Evidence for a phosphorus-depletion syndrome in man. N Engl J Med. 1968;278(8):409–15.

    Article  CAS  PubMed  Google Scholar 

  15. Pivnick EK, Kerr NC, Kaufman RA, Jones DP, Chesney RW. Rickets secondary to phosphate depletion. A sequela of antacid use in infancy. Clin Pediatr. 1995;34(2):73–8.

    Article  CAS  Google Scholar 

  16. Shields HM. Rapid fall of serum phosphorus secondary to antacid therapy. Gastroenterology. 1978;75(6):1137–41.

    Article  CAS  PubMed  Google Scholar 

  17. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ (Clinical research ed). 2008;336(7659):1495–8.

    Article  Google Scholar 

  18. Carpenter TO, Imel EA, Holm IA, Jan de Beur SM, Insogna KL. A clinician's guide to X-linked hypophosphatemia. J Bone Miner Res. 2011;26(7):1381–8.

    Article  Google Scholar 

  19. Assadi F. Hypophosphatemia: an evidence-based problem-solving approach to clinical cases. Iran J Kidney Dis. 2010;4(3):195–201.

    PubMed  Google Scholar 

  20. Yoshimatsu S, Hossain MI, Islam MM, Chisti MJ, Okada M, Kamoda T, et al. Hypophosphatemia among severely malnourished children with sepsis in Bangladesh. Pediatr Int. 2013;55(1):79–84.

    Article  CAS  PubMed  Google Scholar 

  21. Shah SK, Shah L, Bhattarai S, Giri M. Rhabdomyolysis due to severe hypophosphatemia in diabetic ketoacidosis. JNMA. 2015;53(198):137–40.

    CAS  Google Scholar 

  22. Choi HS, Kwon A, Chae HW, Suh J, Kim DH, Kim HS. Respiratory failure in a diabetic ketoacidosis patient with severe hypophosphatemia. Ann Pediatr Endocrinol Metabol. 2018;23(2):103–6.

    Article  Google Scholar 

  23. de Oliveira Iglesias SB, Pons Leite H, de Carvalho WB. Hypophosphatemia-induced seizure in a child with diabetic ketoacidosis. Pediatr Emerg Care. 2009;25(12):859–61.

    Article  PubMed  Google Scholar 

  24. Pajak A, Krolak-Olejnik B, Szafranska A. Early hypophosphatemia in very low birth weight preterm infants. Adv Clin Exp Med. 2018;27(6):841–7.

    Article  PubMed  Google Scholar 

  25. Gonzalez Ballesteros LF, Ma NS, Gordon RJ, Ward L, Backeljauw P, Wasserman H, et al. Unexpected widespread hypophosphatemia and bone disease associated with elemental formula use in infants and children. Bone. 2017;97:287–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Uday S, Sakka S, Davies JH, Randell T, Arya V, Brain C, et al. Elemental formula associated hypophosphataemic rickets. Clin Nutr (Edinburgh, Scotland). 2019;38(5):2246–50.

    Article  CAS  Google Scholar 

  27. Walton RJ, Bijvoet OL. Nomogram for derivation of renal threshold phosphate concentration. Lancet (London, England). 1975;2(7929):309–10.

    Article  CAS  Google Scholar 

  28. Yoshida T, Yoshida N, Monkawa T, Hayashi M, Saruta T. Dietary phosphorus deprivation induces 25-hydroxyvitamin D(3) 1alpha-hydroxylase gene expression. Endocrinology. 2001;142(5):1720–6.

    Article  CAS  PubMed  Google Scholar 

  29. Imel EA, Econs MJ. Approach to the hypophosphatemic patient. J Clin Endocrinol Metab. 2012;97(3):696–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Carpenter TO. The expanding family of hypophosphatemic syndromes. J Bone Miner Metab. 2012;30(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  31. Gohil A, Imel EA. FGF23 and associated disorders of phosphate wasting. Pediatr Endocrinol Rev. 2019;17(1):17–34.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Cemre Robinson

Authors
  1. Cemre Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cemre Robinson .

Editor information

Editors and Affiliations

  1. Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Takara Stanley

  2. Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Madhusmita Misra

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Robinson, C. (2021). Hypophosphatemia. In: Stanley, T., Misra, M. (eds) Endocrine Conditions in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-52215-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52215-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52214-8

  • Online ISBN: 978-3-030-52215-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation