1
|
Bramness JG, Skulberg KR, Skulberg A, Skulberg A. Blood alcohol levels after standardized intake of alcohol are related to measured blood phosphate levels. Clin Biochem 2022; 109-110:90-93. [PMID: 35973618 DOI: 10.1016/j.clinbiochem.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/14/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
Abstract
The role of blood phosphate in alcohol metabolism has not been studied. In this explorative experimental study, the relationship between blood phosphate levels and metabolism of alcohol was investigated. Twenty young male volunteers were given alcohol relative to body weight to make them reach a theoretical blood alcohol concentration (BAC) of 0.12%. Ten measurements of BAC were taken across the time from intake, to peak and total elimination. The results indicated that individuals with high blood phosphate levels achieved a lower BAC maximum than those with low blood phosphate levels. The difference between the highest and lowest maximum BAC was as much as 30-40% and correlated negatively to physiological blood phosphate levels. The results suggest that phosphate plays a role in prehepatic, possibly gastric, alcohol metabolism. The Alcohol Dehydrogenase enzyme 7 (ADH7) is represented in the upper gastrointestinal tract and may be the enzyme responsible for this variation in the blood alcohol concentration reached.
Collapse
Affiliation(s)
- Jørgen G Bramness
- Norwegian Institute of Public Health, Oslo, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway; Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Knut R Skulberg
- Inland Norway University of Applied Sciences, Elverum, Norway; Lillogata 5 P, 0484 Oslo, Norway
| | | | | |
Collapse
|
2
|
Steck DT, Pennington MW, Oxorn DC, Mackensen GB, Sheu RD. Lactic Acidosis in the Setting of Severe Hypophosphatemia After High-Dose Insulin Infusion. J Cardiothorac Vasc Anesth 2020; 35:267-269. [PMID: 32473850 DOI: 10.1053/j.jvca.2020.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dominik T Steck
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA.
| | - Matthew W Pennington
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Donald C Oxorn
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - G Burkhard Mackensen
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Richard D Sheu
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
| |
Collapse
|
3
|
Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Thirunavukkarasu S, Kashani KB. Admission serum phosphate levels and the risk of respiratory failure. Int J Clin Pract 2020; 74:e13461. [PMID: 31830348 DOI: 10.1111/ijcp.13461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the relationship between admission serum phosphate and in-hospital respiratory failure requiring mechanical ventilation in hospitalised patients. METHODS We analysed a cohort of all adult patients admitted at a tertiary referral hospital between the year 2009 and 2013. We included patients who had available serum phosphate and were not on mechanical ventilation within 24 hours of hospital admission. We stratified admission serum phosphate based on its distribution into 6 groups: ≤2.4, 2.5-3.0, 3.1-3.6, 3.7-4.2, 4.3-4.8 and ≥4.9 mg/dL. We performed multivariable logistic regression analysis to assess the odds ratio of in-hospital respiratory failure requiring mechanical ventilation based on admission serum phosphate, using phosphate level of 3.1-3.6 as the reference group. RESULTS This study enrolled a total of 37 728 hospitalised patients, with a mean admission serum phosphate of 3.8 ± 1.1 mg/dL. Of these patients, 2792 (7.4%) developed respiratory failure requiring mechanical ventilation during hospitalisation. Increased incidence of respiratory failure requiring mechanical ventilation was observed in both decreased and increased admission serum phosphate, assuming the J-shaped curve. In adjusted analysis, admission serum phosphate of ≤2.4 and 2.5-3.0 mg/dL was significantly associated with increased risk of respiratory failure requiring mechanical ventilation with odds ratio (OR) of 1.18 (95% confidence interval [CI] 1.01-1.40) and 1.19 (95% CI 1.04-1.35), respectively. Similarly, admission serum phosphate of 4.3 to 4.8 and ≥4.9 mg/dL was significantly associated with increased risk of respiratory failure requiring mechanical ventilation with OR of 1.19 (95% CI 1.05-1.36) and 1.58 (95% CI 1.37-1.82), respectively. CONCLUSION Our study revealed the J-shaped association between serum phosphate level at admission and risk of respiratory failure requiring mechanical ventilation in unselected hospitalised patients.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Sorkko Thirunavukkarasu
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Hypophosphatemia as a Predictor of Organ-Specific Complications Following Gastrointestinal Surgery: Analysis of 8034 Patients. World J Surg 2019; 43:385-394. [PMID: 29955938 DOI: 10.1007/s00268-018-4726-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Organ-specific complications (OSC) remain serious potential sequela of gastrointestinal surgery. Hypophosphatemia correlates with poor outcomes and may be a harbinger of OSC after gastrointestinal surgery. Our goal was to describe and evaluate the relationship between postoperative phosphate levels and OSC. METHODS Consecutive patients who underwent pancreatic, colorectal, or gastric resections were analyzed. OSC were defined as those resulting from the failure of at least one anastomosis performed during the primary resection, manifesting as an anastomotic leak, fistula, and/or intra-abdominal abscess. Postoperative serum phosphate levels and other recognized OSC risk factors were compared among patients who did and did not develop OSC. RESULTS A total of 8034 patients who underwent pancreatic (n = 397), colorectal (n = 5808), or gastric (n = 1829) resections were included in the study. In each resection group, the majority of patients experienced hypophosphatemia postresection with the nadir on postoperative day (POD) 2, and the subgroups that developed OSC exhibited lower phosphate levels on POD3-7. On multivariate analysis, lower phosphate level on POD3 remained significantly associated with OSC following pancreatic resection [median (interquartile range) mmol/L, 0.65 (0.53-0.76) vs. 0.71 (0.61-0.84), p = 0.045] and colorectal resection [0.71 (0.61-0.87) vs. 0.77 (0.65-0.94), p = 0.006], and lower phosphate level on POD4 remained associated with OSC following gastric resection [0.87 (0.74-1.03) vs. 0.96 (0.81-1.13), p = 0.049]. CONCLUSION This study identified a consistent trajectory of serum phosphate levels following 3 different gastrointestinal operations and association between early postoperative phosphate levels and OSC. Persistent lower phosphate levels should raise the level of concern for evolving postoperative leak and may lead to earlier radiographic evaluation and treatment.
Collapse
|
5
|
Ha S, Park S, Kim H, Go H, Lee SH, Choi JY, Hong JY, Ryu JS. Successful Localization Using 68Ga-DOTATOC PET/CT of a Phosphaturic Mesenchymal Tumor Causing Osteomalacia in a Patient with Concurrent Follicular Lymphoma. Nucl Med Mol Imaging 2018; 52:462-467. [PMID: 30538778 DOI: 10.1007/s13139-018-0546-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 01/13/2023] Open
Abstract
Diagnosing tumor-induced osteomalacia is often challenging because conventional imaging modalities may fail to locate the responsible tumor. This report describes the ability of 68Ga-DOTATOC PET/CT to successfully distinguish between the responsible phosphaturic mesenchymal tumor and concurrent lymphoma lesions. A 52-year-old man with bone pain for several years was diagnosed with a vitamin D-resistant hypophosphatemic osteomalacia. Whole body 18F-FDG PET/CT revealed multiple enlarged hypermetabolic lymph nodes in his bilateral cervical, axillary, mediastinal, abdominal, pelvic, and inguinal regions. Core needle biopsy of the right cervical lymph node confirmed the diagnosis of follicular lymphoma. However, lymphoma was not considered the cause of osteomalacia. 68Ga-DOTATOC PET/CT before chemotherapy showed a small nodule with intensely increased uptake in the right inguinal region, which was distinguished from the other enlarged lymph nodes. The nodule was surgically removed and histopathologically consistent with phosphaturic mesenchymal tumor. After surgery, the patient's serum phosphorus and alkaline phosphatase levels normalized without nutritional supplement.
Collapse
Affiliation(s)
- Sejin Ha
- 1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 South Korea
| | - Sujin Park
- 1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 South Korea
| | - Hyunji Kim
- 1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 South Korea
| | - Heounjeong Go
- 2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hun Lee
- 3Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Yoon Choi
- 4Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Yong Hong
- 5Department of Oncology, and Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- 1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 South Korea
| |
Collapse
|
6
|
Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Sakhuja A, Erickson SB. Admission serum phosphate levels predict hospital mortality. Hosp Pract (1995) 2018; 46:121-127. [PMID: 29848117 DOI: 10.1080/21548331.2018.1483172] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The aim of this study was to assess the relationship between admission serum phosphate levels and in-hospital mortality in all hospitalized patients. METHODS All adult hospitalized patients who had admission serum phosphate available between years 2009 and 2013 were enrolled. Admission serum phosphate was categorized based on its distribution into six groups (<2.5, 2.5-3.0, 3.1-3.6, 3.7-4.2, 4.3-4.8 and ≥4.9 mg/dL). The odds ratio (OR) of in-hospital mortality by admission serum phosphate, using the phosphate category of 3.1-3.6 mg/dL as the reference group, was obtained by logistic regression analysis. RESULTS 42,336 patients were studied. The lowest incidence of in-hospital mortality was associated with a serum phosphate within 3.1-4.2 mg/dL. A U-shaped curve emerged demonstrating higher in-hospital mortality associated with both serum phosphate <3.1 and >4.2 mg/dL. After adjusting for potential confounders, both serum phosphate <2.5 and >4.2 mg/dL were associated with in-hospital mortality with ORs of 1.60 (95%CI 1.25-2.05), 1.60 (95%CI 1.29-1.97), and 3.89 (95%CI 3.20-4.74) when serum phosphate were <2.5, 4.3-4.8 and ≥4.9 mg/dL, respectively. Among subgroups of patients with chronic kidney disease (CKD) and cardiovascular disease (CVD), the highest mortality was associated with a serum phosphate ≥4.9 mg/dL with ORs of 4.11 (95%CI 3.16-5.39) in CKD patients and 5.11 (95%CI 3.33-7.95) in CVD patients. CONCLUSION Hospitalized patients with admission serum phosphate <2.5 and >4.2 mg/dL are associated with an increased risk of in-hospital mortality. The highest mortality risk is associated with CKD and CVD patients with admission hyperphosphatemia.
Collapse
Affiliation(s)
- Wisit Cheungpasitporn
- a Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic , Rochester , MN , USA.,b Division of Nephrology, Department of Medicine , University of Mississippi Medical Center , Jackson , MS , USA
| | - Charat Thongprayoon
- a Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic , Rochester , MN , USA.,c Department of Internal Medicine , Bassett Medical Center , Cooperstown , NY , USA
| | - Michael A Mao
- a Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | | | - Ankit Sakhuja
- d Division of Pulmonary and Critical Care Medicine, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Stephen B Erickson
- a Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
7
|
Şen E, Öner İ, Ata Ö. Imatinib and hypophosphatemia: Case report and review of literature. JOURNAL OF ONCOLOGICAL SCIENCES 2017. [DOI: 10.1016/j.jons.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
8
|
Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, Fiedler GM, Fuhrmann V, Exadaktylos AK. Hyperphosphatemia Is an Independent Risk Factor for Mortality in Critically Ill Patients: Results from a Cross-Sectional Study. PLoS One 2015; 10:e0133426. [PMID: 26252874 PMCID: PMC4529074 DOI: 10.1371/journal.pone.0133426] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Phosphate imbalances or disorders have a high risk of morbidity and mortality in patients with chronic kidney disease. It is unknown if this finding extends to mortality in patients presenting at an emergency room with or without normal kidney function. METHODS AND PATIENTS This cross sectional analysis included all emergency room patients between 2010 and 2011 at the Inselspital Bern, Switzerland. A multivariable cox regression model was applied to assess the association between phosphate levels and in-hospital mortality up to 28 days. RESULTS 22,239 subjects were screened for the study. Plasma phosphate concentrations were measured in 2,390 patients on hospital admission and were included in the analysis. 3.5% of the 480 patients with hypophosphatemia and 10.7% of the 215 patients with hyperphosphatemia died. In univariate analysis, phosphate levels were associated with mortality, age, diuretic therapy and kidney function (all p<0.001). In a multivariate Cox regression model, hyperphosphatemia (OR 3.29, p<0.001) was a strong independent risk factor for mortality. Hypophosphatemia was not associated with mortality (p>0.05). CONCLUSION Hyperphosphatemia is associated with 28-day in-hospital mortality in an unselected cohort of patients presenting in an emergency room.
Collapse
Affiliation(s)
- Dominik G. Haider
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, Switzerland
- * E-mail:
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, Switzerland
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, Vienna, Austria
| | - Sufian S. Ahmad
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, Switzerland
| | - Thomas Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, Switzerland
| | | | - Georg-Martin Fiedler
- Center of Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, Switzerland
| |
Collapse
|
9
|
Håglin L. Using phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbance. Nutr Neurosci 2015; 19:213-23. [DOI: 10.1179/1476830515y.0000000024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lena Håglin
- Department of Public Health and Clinical Medicine, Sweden
| |
Collapse
|
10
|
Abstract
Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.
Collapse
Affiliation(s)
- P Manghat
- Department of Chemical Pathology, Darent Valley Hospital, Dartford, UK
| | - R Sodi
- Department of Biochemistry, NHS Lanarkshire, East Kilbride, UK
| | - R Swaminathan
- Department of Chemical Pathology, St. Thomas Hospital, London, UK
| |
Collapse
|
11
|
Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open 2013; 3:e002173. [PMID: 23315514 PMCID: PMC3549252 DOI: 10.1136/bmjopen-2012-002173] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement. OBJECTIVE To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support. DESIGN Prospective cohort study. SETTING Large, single site university teaching hospital. Recruitment period 2007-2009. PARTICIPANTS 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care. MAIN OUTCOME MEASURES PRIMARY OUTCOME occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality. RESULTS 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes. CONCLUSIONS Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.
Collapse
Affiliation(s)
- Alan Rio
- Department of Nutrition and Dietetics, King's College Hospital, London, UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | - Louise Goff
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | | | - Nigel Smeeton
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| |
Collapse
|
12
|
Lhotská J, Pechman V, Čech J, Opatrný J, Hromádka M, Rokyta R. Early phosphatemia changes in acute cardiac care patients. COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Abstract
Kinnier Wilson coined the term metabolic encephalopathy to describe a clinical state of global cerebral dysfunction induced by systemic stress that can vary in clinical presentation from mild executive dysfunction to deep coma with decerebrate posturing; the causes are numerous. Some mechanisms by which cerebral dysfunction occurs in metabolic encephalopathies include focal or global cerebral edema, alterations in transmitter function, the accumulation of uncleared toxic metabolites, postcapillary venule vasogenic edema, and energy failure. This article focuses on common causes of metabolic encephalopathy, and reviews common causes, clinical presentations and, where relevant, management.
Collapse
Affiliation(s)
- Michael J Angel
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | |
Collapse
|
14
|
Angel MJ, Chen R, Bryan Young G. Metabolic encephalopathies. HANDBOOK OF CLINICAL NEUROLOGY 2010; 90:115-66. [PMID: 18631820 DOI: 10.1016/s0072-9752(07)01707-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Michael J Angel
- University of Toronto, Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
15
|
Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R147. [PMID: 20682049 PMCID: PMC2945130 DOI: 10.1186/cc9215] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 06/02/2010] [Accepted: 08/03/2010] [Indexed: 01/10/2023]
Abstract
Introduction Currently no evidence-based guideline exists for the approach to hypophosphatemia in critically ill patients. Methods We performed a narrative review of the medical literature to identify the incidence, symptoms, and treatment of hypophosphatemia in critically ill patients. Specifically, we searched for answers to the questions whether correction of hypophosphatemia is associated with improved outcome, and whether a certain treatment strategy is superior. Results Incidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Treatment: hypophosphatemia is generally corrected when it is symptomatic or severe. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Outcome: in some studies, hypophosphatemia was associated with higher mortality; a paucity of randomized controlled evidence exists for whether correction of hypophosphatemia improves the outcome in critically ill patients. Conclusions Additional studies addressing the current approach to hypophosphatemia in critically ill patients are required. Studies should focus on the association between hypophosphatemia and morbidity and/or mortality, as well as the effect of correction of this electrolyte disorder.
Collapse
Affiliation(s)
- Daniël A Geerse
- Department of Intensive Care Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands.
| | | | | | | | | | | |
Collapse
|
16
|
Bagnis CI, Karie S, Deray G, Essig M. Hypophosphataemia: An Easy Strategy for Diagnosis and Treatment in HIV Patients. Antivir Ther 2009. [DOI: 10.1177/135965350901400404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because HIV infection has become a chronic disease, it is crucial that metabolic complications secondary to HIV infection or prolonged therapy be diagnosed and managed appropriately over time. Therefore the optimal follow-up becomes complex and time consuming. Our review aimed to provide physicians in charge of HIV-infected patients with key data helping them to diagnose and understand hypophosphataemia in HIV patients. Hypophosphataemia is frequent and sometimes secondary to renal phosphate wasting. It is very rarely a component of a complex proximal tubular disorder, such as Fanconi syndrome. When isolated, hypophosphataemia is easy to rule out and treat. In rare cases, prolonged hypophosphataemia, when related to renal phosphate wasting and tubular dysfunction, might have potential consequences on bone outcome, however, more studies are needed. HIV infection by itself might be a risk factor for bone metabolism abnormalities; antiretroviral drugs might also be involved. Therefore, it seems valuable for patients that the minimal screening should be performed routinely, in order to prevent long-term disabilities.
Collapse
Affiliation(s)
| | - Svetlana Karie
- Nephrology Department, Pitie Salpetriere Hospital, Paris, France
| | - Gilbert Deray
- Nephrology Department, Pitie Salpetriere Hospital, Paris, France
| | - Marie Essig
- Nephrology Department, Dupuytren Hospital, Limoges, France
| |
Collapse
|
17
|
Izzedine H, Bahleda R, Khayat D, Massard C, Magné N, Spano JP, Soria JC. Electrolyte disorders related to EGFR-targeting drugs. Crit Rev Oncol Hematol 2009; 73:213-9. [PMID: 19403315 DOI: 10.1016/j.critrevonc.2009.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 03/19/2009] [Accepted: 03/27/2009] [Indexed: 11/17/2022] Open
Abstract
It is now clearly established that anti-vascular endothelial growth factor (VEGF) drug class induces hypertension and proteinuria sometimes related to thrombotic microangiopathy and/or various glomerulopathies, according to capillary and glomerular VEGF and VEGF-receptor expressions. As reported in the literature, anti-epidermal growth factor receptor (EGFR) therapies seem to be less nephrotoxic. Indeed, many reports of anti-EGFR nephrotoxicity are tubular dependent such as acute tubular necrosis, electrolyte disorders (hypophosphatemia, hypomagnesemia, etc.) or both. This is explained by elective tubular expression of renal EGF/EGFR. In this paper, we focus on electrolyte disorders related to anti-EGFR treatment and discuss the tubular involvement of these drugs based on their renal expression.
Collapse
Affiliation(s)
- Hassane Izzedine
- Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
18
|
Sumukadas D, Jenkinson F, Witham MD. Associations and consequences of hypophosphataemia in older hospitalised women. Age Ageing 2009; 38:112-5. [PMID: 18984576 DOI: 10.1093/ageing/afn244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Deepa Sumukadas
- Medicine for the Elderly, Section of Ageing & Health, Ninewells Hospital & Medical School, NHS Tayside, Dundee DD1 9SY, UK.
| | | | | |
Collapse
|
19
|
Hoffmann M, Zemlin AE, Meyer WP, Erasmus RT. Hypophosphataemia at a large academic hospital in South Africa. J Clin Pathol 2008; 61:1104-7. [DOI: 10.1136/jcp.2007.054940] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim:The aim of this study was to determine the most common causes of hypophosphataemia (⩽0.5 mmol/l) in a hospital population in order to identify patient groups at risk of developing the condition.Methods:The study was conducted at Tygerberg Hospital, a tertiary care centre in the Western Cape, South Africa. All patients identified with a phosphate level ⩽0.5 mmol/l during an 18-month period were included in the study. Medical records of these patients were reviewed.Results:Of all the requests received for serum phosphate determination by the laboratory, 2% (861 out of 45 394 requests) were ⩽0.5 mmol/l. Thirty per cent (30%; n = 189) of the patients in the study population died during their hospital stay. Most (45%; n = 278) of the patients with low phosphate levels occurred in an intensive care setting, whereas 10% (n = 63) were most likely due to refeeding, and 6% (n = 35) had neoplastic disease. Sepsis was implicated as a contributing factor in 26% (n = 162).Conclusion:Severe hypophosphataemia is associated with a very high mortality (30%, n = 189). Patients with a high risk of developing hypophosphataemia include those in an intensive care unit (ICU), patients suffering from neoplastic diseases, possible refeeding syndrome and septic patients. Regular phosphate determination is recommended in these patients to facilitate early diagnosis of hypophosphataemia.
Collapse
|
20
|
Hemstreet BA, Stolpman N, Badesch DB, May SK, McCollum M. Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety. Curr Med Res Opin 2006; 22:2449-55. [PMID: 17257459 DOI: 10.1185/030079906x148463] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Evaluate potassium and phosphorus repletion in hospitalized patients. Assess the potential role for use of various methods, including healthcare information technology, to improve prescribing and patient safety. RESEARCH DESIGN AND METHODS Inpatient medication profiles were screened to identify orders for potassium and phosphorus replacement products. Electronic laboratory and medical records were used to evaluate efficacy and safety. Eligibility for oral therapy was defined by the presence of other scheduled oral medications on the medication profile. Appropriateness of prescribing was based on adherence to the hospital guidelines for repletion. RESULTS Overall, 134 orders for potassium in 92 patients and 36 orders for phosphorus in 27 patients were evaluated over a 3-week data collection period. Intravenous (IV) potassium was prescribed in 73% of replacement episodes (46% as single doses and 54% within large volume IV fluids), with 85% for normokalemia or mild-to-moderate cases of hypokalemia. Phosphorus orders involved single doses of IV potassium phosphate (mean 13.1 mmol) in 75% of cases. Approximately 85% of doses were for mild or moderate hypophosphatemia. Eligibility for oral therapy was evident in 74% of normokalemic or mild hypokalemic cases receiving IV potassium products and in 33% of cases receiving IV phosphorus replacement. Six cases of mild hyperkalemia were observed. No hyperphosphatemia was documented. Study limitations include use of a retrospective design, inability to discern whether some electrolyte doses were given with a preventative intent, potential overestimation of the number of patients eligible for oral repletion, and lack of data on the accessibility of the laboratory serum concentrations or the awareness of serum values to the prescribers. CONCLUSIONS Intravenous potassium and phosphate products are commonly prescribed for mild or moderate cases of hypokalemia or hypophosphatemia. Many patients met eligibility for oral therapy. Efforts to enhance prescriber education and implement computerized prescribing and decision support systems have the potential to improve prescribing and reduce possibilities of adverse drug events and medication errors related to potassium and phosphate administration.
Collapse
Affiliation(s)
- Brian A Hemstreet
- Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center School of Pharmacy, Denver, CO 80262, USA
| | | | | | | | | |
Collapse
|
21
|
Abstract
Phosphate plays a key role in several biological processes. In recent years, new insights have been obtained into the regulation of the phosphate metabolism, including a growing amount of evidence suggesting that factors other than parathyroid hormone (PTH) and vitamin D are involved in maintaining the phosphate balance. A new class of phosphate-regulating factors, the so-called "phosphatonins," have been shown to be important in phosphate-wasting diseases. However, the role of the phosphatonins in the normal human homeostasis remains to be established. The incidence of hypophosphatemia in selected patient series can be more than 20%, with clinical sequelae ranging from mild to life threatening. Only when combined with phosphate depletion does hypophosphatemia become clinically significant. The factors that are involved in the phosphate homeostasis, the pathophysiology, the relevance in patient care, the clinical manifestations, and an appropriate management of phosphate depletion are discussed in this review.
Collapse
Affiliation(s)
- André Gaasbeek
- Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | | |
Collapse
|
22
|
Wright JD, Chaudhari A, Sadovsky Y. Is hypotonic dysfunctional labor associated with hypophosphatemia? Am J Obstet Gynecol 2004; 190:1447-9. [PMID: 15167865 DOI: 10.1016/j.ajog.2004.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether hypotonic dysfunctional labor is associated with hypophosphatemia. STUDY DESIGN We conducted a prospective nested case control study of term women who were in active labor. Serum phosphate samples were drawn at admission with active labor and before delivery. Phosphate concentration was compared between control subjects and women with hypotonic, dysfunctional uterine contractions. RESULTS Both serum samples were available for 90 women. Hypophosphatemia was documented in 14% of the participants. There was no significant difference in phosphate concentration between the 2 groups either at admission or before delivery. The mean decrease in phosphate concentration between admission and delivery was similar between the 2 cohorts. CONCLUSION Although transient hypophosphatemia is found commonly in laboring women, hypotonic dysfunctional contractions are not associated with mild hypophosphatemia.
Collapse
Affiliation(s)
- Jason D Wright
- Departments of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | | | | |
Collapse
|
23
|
Håglin L, Burman LA, Nilsson M. High prevalence of hypophosphataemia amongst patients with infectious diseases. A retrospective study. J Intern Med 1999; 246:45-52. [PMID: 10447224 DOI: 10.1046/j.1365-2796.1999.00540.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the prevalence of hypophosphataemia amongst all patients treated during 1993 for infectious diseases. The associations between serum C-reactive protein, serum albumin and white blood cells in blood were studied amongst hypophosphataemic patients. Comparisons were made according to the severity of infection. DESIGN A retrospective study of the prevalence of hypophosphataemia, and a case-control study amongst a subgroup of patients. SETTING The Department of Infectious Diseases, University Hospital, Umeå, Sweden. SUBJECTS For the prevalence study all 967 patients (449 women and 518 men) treated during 1993 were included. In the case-control study, 108 cases, with serum phosphate < or =0.64 mmol L(-1), 216 age-and sex-matched controls with serum phosphate >0.82 mmol L(-1) (men) and >0.86 mmol L(-1) (women), respectively, were included. RESULTS In 402 of 967 patients (42%) at least one serum phosphate value was below the reference level. Hypophosphataemia was found in 573 of 1966 blood samples (29%). Severe hypophosphataemia (<0.30 mmol L(-1)) was seen in 1.2% of the patients (0.9% of blood samples). The prevalence of hypophosphataemia was higher amongst women than amongst men. In the case-control study, the serum C-reactive protein and the number of white blood cells was higher amongst the cases compared with the controls (124 vs. 94 mg L(-1) and 11.4 vs. 9.3 cells/L x10(9), respectively). The multiple logistic regression showed a 4-fold higher risk of having low serum phosphate in patients with severe infection, compared with mild infections. None of the other variables (albumin, days of hospital stay or white blood cells in blood) increased the risk for hypophosphataemia. CONCLUSIONS The high prevalence of low serum phosphate levels and the increased risk of having low levels in severe infections shown in this study needs further attention.
Collapse
Affiliation(s)
- L Håglin
- Department of Social Medicine, University Hospital, Umeå, Sweden.
| | | | | |
Collapse
|
24
|
Guy JM, Stewart MF, Olukoga A, Horsman G, McMurray JR. Hypophosphataemia in general practice patients. Ann Clin Biochem 1999; 36 ( Pt 1):37-42. [PMID: 10370758 DOI: 10.1177/000456329903600104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared plasma phosphate concentrations in general practice patients and hospital inpatients and outpatients over an 8-month period. The distribution of results in all three groups was similar and 12-16% of results were at or below 0.8 mmol/L. In general practice patients, 8.3% of results from males and 12.1% from females were below the lower limit of their respective reference ranges. Eighteen of these patients (0.2% of results) had plasma phosphate concentrations < or = 0.4 mmol/L. On follow-up, only two of these patients had any attributable cause for their severe hypophosphataemia; in the remainder, it was unexpected and unexplained. Hypophosphataemia in outpatients and general practice patients is more common than has previously been appreciated. We present a strategy for further investigation of these patients.
Collapse
Affiliation(s)
- J M Guy
- Department of Clinical Biochemistry, Salford Royal Hospitals NHS Trust, Hope Hospital, UK
| | | | | | | | | |
Collapse
|
25
|
Abstract
A summary of new findings regarding alterations of magnesium (Mg2+) and phosphorus (P) metabolism are reviewed for the clinician caring for patients in general wards. Alterations in serum concentrations of Mg2+ and P are frequently observed in acute or very ill patients in emergency rooms or intensive-care areas. A significant proportion of these alterations are iatrogenic. Most of the symptoms related are non-specific, and usually they are associated with changes in concentration of other ions. The need to measure Mg2+ and P routinely and to define better the real abnormal values is stressed. Correction of the abnormalities must be early in the course of the alterations.
Collapse
Affiliation(s)
- J R Weisinger
- Department of Medicine, Universidad Central de Venezuela, Hospital Universitario de Caracas.
| | | |
Collapse
|
26
|
Abstract
Severe hypophosphatemia has rarely been reported as a cause of acute paralysis. We present the clinical and electrophysiological findings on a patient who developed quadriparesis following several surgeries for complicated cholecystectomy. The paralysis was most likely the result of severe hypophosphatemia causing a neuropathy which improved readily after proper phosphate replacement. The possible pathogenic mechanisms of hypophosphatemic neuropathy are discussed.
Collapse
Affiliation(s)
- M F Siddiqui
- Department of Neurology, University of Tennessee, Memphis 38163, USA
| | | |
Collapse
|
27
|
Affiliation(s)
- D E Hall
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| | | | | |
Collapse
|
28
|
Young IS, Bailie K, Trimble ER. Severe hypophosphataemia in a patient with acute leukaemia. Ann Clin Biochem 1993; 30 ( Pt 3):326-8. [PMID: 8155103 DOI: 10.1177/000456329303000318] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- I S Young
- Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | | | | |
Collapse
|
29
|
Abstract
Severe hypophosphatemia may develop in postoperative patients for several reasons including alcohol withdrawal, diabetic ketoacidosis, nutritional recovery (refeeding) syndrome, and severe respiratory alkalosis. Severe hypophosphatemia may result in central nervous system abnormalities, muscle weakness, and renal, hepatic, cardiac, and respiratory dysfunction. Hypophosphatemia may be prevented by close monitoring of phosphorus concentrations in serum, especially in patients predisposed to developing this problem. Proper techniques for the maintenance and repletion of phosphate for both enteral and parenteral use are described.
Collapse
|