Hyperphosphatemia

Aka: Hyperphosphatemia, High Serum Phosphorus

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II. Causes

  1. Renal Failure
  2. Dehydration
  3. Addison's Disease
  4. Hypervitaminosis D
  5. Hypoparathyroid
  6. Magnesium Deficiency
  7. Milk-Alkali Syndrome
  8. Transfusions
  9. Hemolysis
  10. Sarcoidosis
  11. Bone metastases
  12. Myelogenous Leukemia

III. Evaluation: Renal Failure

  1. Chronic Renal Failure
    1. Increased phosphate when GFR falls below 20 ml/min
    2. Usually Phosphate in 5-10 mg/dl range
  2. Acute Renal Failure
    1. Especially in oliguric or hypercatabolic forms
    2. Highest in:
      1. Myoglobinuric Acute Tubular Necrosis
      2. Surgery
      3. Trauma

IV. Evaluation: Normal Renal Function

  1. Check Urinary phosphate excretion (Urine pHosphate)
  2. Increased Urine pHosphate: over 1500 mg/dl
    1. Endogenous source
      1. Cytotoxins
      2. Rhabdomyolysis
      3. Malignant hyperpyrexia (Fever)
    2. Exogenous source
      1. Laxative Abuse
      2. Enemas
      3. Phosphate (Oral, IV, or Poisoning)
  3. Normal Urine pHosphate: Under 1500mg/dl
    1. Increased reabsorption
      1. Hyperparathyroidism
      2. Menopause
      3. Extracellular Fluid Volume contraction
      4. Tumoral calcinosis

V. Management

  1. Antacid binding gel: Aluminum hydroxide (AlternaGel)
    1. Dose 600 mg/5 ml, 5 ml qid with meals and at bedtime
  2. Low Phosphate diet

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