• Clinical science
  • Clinician



Hypophosphatemia is defined as a serum phosphate of < 2.5 mg/dL. It is more common in patients with alcohol use disorder and in critically unwell patients, who have high phosphate demands. Particularly in mild deficiency, symptoms can be nonspecific or absent entirely. However, severe hypophosphatemia can cause serious complications such as seizures, respiratory failure, and arrhythmias. Treatment may be oral or intravenous, depending on the severity of the deficiency, and should occur in conjunction with investigation of underlying causes. Supplementation regimens are covered in electrolyte repletion.


  • Serum phosphate of < 2.5 mg/dL [1]
  • Severe hypophopshatemia occurs at < 1 mg/dL. [1]



Cause [2][3][4]

Increased renal excretion

Insufficient intestinal absorption

Transcellular phosphate shifts

Extreme catabolic states


Clinical features

Although mild hypophosphatemia rarely causes symptoms, moderate to severe hypophosphatemia is associated with various cardiac, musculoskeletal, neurological, and hematological abnormalities. [3][4]



We list the most important complications. The selection is not exhaustive.

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  • 6. Wrighton LJ, O'Bosky KR, Namm JP, Senthil M. Postoperative management after hepatic resection. J Gastrointest Oncol. 2012; 3(1): pp. 41–7. doi: 10.3978/j.issn.2078-6891.2012.003.
  • 7. Demirjian S, Teo BW, Guzman JA, et al. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant. 2011; 26(11): pp. 3508–3514. doi: 10.1093/ndt/gfr075.
  • 8. Suki WN, Massry SG. Therapy of Renal Diseases and Related Disorders. Springer Science & Business Media; 2012.
  • 9. Liamis G, Milionis HJ, Elisaf M. Medication-induced hypophosphatemia: a review. QJM. 2010; 103(7): pp. 449–459. doi: 10.1093/qjmed/hcq039.
  • 10. Srivastava R, Bagga A. Pediatric Nephrology. JP Medical Ltd; 2016.
  • 11. Lervang H-H, Ditzel J. Disturbance of inorganic phosphate metabolism in diabetes mellitus: clinical manifestations of phosphorus-depletion syndrome during recovery from diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2010: p. 319. doi: 10.2147/dmsott.s13476.
  • 12. Suarez N, Conway N, Pickett T. Panic-related hyperventilation resulting in hypophosphataemia and a high lactate. BMJ Case Rep. 2013; 2013(may09 1): pp. bcr2013009307–bcr2013009307. doi: 10.1136/bcr-2013-009307.
  • Lewis, J. Hypophosphatemia. https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypophosphatemia. Updated March 1, 2018. Accessed January 2, 2020.
last updated 09/22/2020
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