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Treatment of hypophosphatemia or low serum phosphate levels can include treating the underlying cause, dietary changes, or surgery.
The treatment of hypophosphatemia or low serum phosphate levels largely depends upon:
- The cause of hypophosphatemia
- The severity of hypophosphatemia
- The duration of hypophosphatemia
Depending on these factors, the doctor may decide the management of the condition with treatment options such as:
- Treatment of the underlying cause:
- The trigger or precipitating factor for hypophosphatemia needs to be identified and managed as per the protocol.
- Triggers may include:
- diabetic ketoacidosis or DKA,
- renal failure,
- malnutrition,
- liver diseases,
- alcoholism,
- vitamin D deficiencies, and
- certain medications (antacids, diuretics, certain herbal preparations, and herbal preparations).
- Dietary changes:
- These include ensuring adequate hydration and consuming phosphate-rich foods such as:
- Dairy products (milk, cheese, yogurt, cream, ice cream, cottage cheese). One quart of cow's milk provides about the amount of phosphate consumed by the average person in a day.
- Meat, chicken, fish, and eggs
- Nuts and seeds
- Beans including soy
- Peas and lentils
- Wheat germ, granola, bran cereal, and oatmeal
- These include ensuring adequate hydration and consuming phosphate-rich foods such as:
- Oral phosphate supplementation:
- It may be done in mild to moderate cases of hypophosphatemia (serum phosphate levels between 1.0 and 1.9 mg/dL).
- The dosages are determined by the doctor based upon the patient’s age and severity of hypophosphatemia.
- Intravenous phosphate:
- Given for the treatment of severe hypophosphatemia (serum phosphate levels lower than 1.0 mg/dL).
- Intravenous phosphate supplementation is particularly helpful in seriously ill patients or those who cannot take supplements orally or those who have severe malabsorption.
- Serum phosphate levels are assessed every six hours during intravenous phosphate supplementation. Once the phosphate levels are above 1.5 mg/dL, oral phosphate supplementation is started.
- Other treatments:
- Calcium supplementation and vitamin D supplementation.
- Burosumab (Crysvita) is a U.S. Food and Drug Administration–approved medication used for the treatment of some genetic causes of hypophosphatemia.
- Surgery:
- May be needed in people who have hypophosphatemia due to a tumor or an overactive parathyroid gland (primary hyperparathyroidism).
- Surgery may involve removal of the parathyroid gland (parathyroidectomy) or the tumor that is causing hypophosphatemia.
What is hypophosphatemia?
Hypophosphatemia is a condition in which the phosphate levels in the blood are lower than normal.
- About 99 percent of the phosphate is present inside the cells (intracellular) and is used for various functions such as:
- DNA and RNA formation,
- energy storage and production,
- cell membrane structure, and
- transport of various important substances including oxygen.
The normal phosphate levels range between 2.5 and 4.5 mg/dL (0.81-1.45 mmol/L) in adults. They are higher in neonates and children and may be as high as 7 mg/dL in infants.
Hypophosphatemia is defined as serum phosphate levels lower than 2.5 mg/dL and is classified into three categories:
(2-2.5 mg/dL or 0.65-0.81 mmol/L)
(1-2 mg/dL or 0.32-0.65 mmol/L)
(<1 mg/dL or 0.32 mmol/L)
What are the symptoms of hypophosphatemia?
Most people with hypophosphatemia do not have any symptoms (asymptomatic).
Symptoms generally appear in people with severe hypophosphatemia and may include:
- Weakness
- Bone pain
- Diplopia (double vision)
- Dysphagia (difficulty swallowing)
- Dysarthria (trouble speaking)
- Pins and needles sensation
- Numbness
- Confusion or altered mental status
- Irritability
- Chest pain or pressure
- Breathing difficulty
- Tremors
- Seizures
- Coma
