Hypophosphatemia & Hyperphosphatemia

 
Hypophosphatemia:
Risk Factors:

• Alcoholism
• Chronic diarrhea
• Starvation
• Vitamin D deficiency

Manifestations:

• Phosphorus < 2.5 mg/dL
• Muscle weakness
• Decreased DTRs
• Hypercalciuria/renal stones
• Dysrhythmias
• Confusion
• Anxiety
• Lethargy/coma 

Interventions:

• Correct etiology
• Oral phosphate replacement
• Vitamin D
• Decrease calcium level
  
  Hyperphosphatemia:
  Risk Factors:
  
• Renal failure
• Chemotherapy
• High vitamin D
• High phosphorus intake
• Excessive enema use [Fleet’s]

Manifestations:

• Phosphorus > 4.5 mg/dL
• Tetany, cramps
• Paresthesias
• Dysrhythmias
• Trousseau’s sign
• Chvostek’s sign
• Seizures

Interventions:

• Aluminum hydroxide [with meals]
• Decrease dialysis