Hypophosphataemia (phosphorus deficiency)

Plasma phosphate below 0.8 mmol/L (2.5 mg/dL). Typical causes: refeeding syndrome in severe weight loss, chronic alcoholism, recovery phase of DKA, prolonged aluminium-containing antacids, vitamin D deficiency, rickets. Symptoms: muscle weakness, rhabdomyolysis, respiratory failure from diaphragmatic weakness, haemolysis, confusion. Severe hypophosphataemia below 0.3 mmol/L requires IV phosphate.

ICD-10 E83.31 drug

Also known as: Low serum phosphate, Refeeding syndrome, Phosphate deficiency

Drugs used for this condition

BPhosphorusFirst line · Structural macromineral of bone and ATP; pharmaceutical and parenteral forms are potassium, sodium and calcium phosphatesPhosphorus preparations are used for confirmed hypophosphataemia: refeeding syndrome in severely undernourished patients, after prolonged fasting, in chronic alcoholism, recovery from diabetic ketoacidosis, oncology with rapid tumour growth, Fanconi syndrome and hypophosphataemic rickets. Strategy: oral phosphates 30–80 mmol/day in moderate hypophosphataemia (0.3–0.8 mmol/L) and IV phosphates 0.08–0.32 mmol/kg every 6 hours in severe forms (below 0.3 mmol/L) with mandatory monitoring of calcium, potassium, magnesium and renal function. Guidelines: ASPEN 2020 and Spanish SENPE 2022. AEMPS registered Phosphate Sandoz with these indications.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit