What to know about hypophosphatemia

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The body forms phosphate by combining the mineral phosphorus with oxygen. Phosphate plays a role in nearly every cellular function. Variations in phosphate levels can affect many parts of a person’s body.

People need phosphate for:

• energy
• bone formation
• making DNA

They obtain it in their diet and store about 85% of it in their bones.

The body regulates phosphate and keeps it within a narrow range in a process that involves hormones, the digestive system, and the kidneys. Phosphate levels that are either too high or too low can cause adverse health effects.

Medical professionals define hypophosphatemia as an adult serum phosphate level of less than 2.5 milligrams per deciliter (mg/dL). Serum is a liquid component of blood. Experts advise that hypophosphatemia is a relatively common abnormality that healthcare professionals often discover incidentally.

Experts advise that most people with hypophosphatemia are asymptomatic, which means they do not experience any symptoms. Doctors usually find out if a person has the condition by incident.

The effects of hypophosphatemia may be broad and can affect nearly every body system. Symptoms may only become apparent at serum phosphate levels below 0.32 millimoles per liter (mmol/L).

Symptoms of mild hypophosphatemia may include a general feeling of weakness. However, symptoms of severe hypophosphatemia may consist of the following:

• altered mental status
• numbness or weakness in the reflexes
• muscle pain or weakness
• neurological instability, including seizures
• heart failure

Hypophosphatemia has several causes and risk factors, including medical conditions, medications, and lifestyle factors.

It is much more prevalent (up to 80%) in people with the following conditions:

• alcohol use disorder
• sepsis
• diabetic ketoacidosis

People may also develop hypophosphatemia due to low amounts of phosphorus in their diet. In the United States, many people’s diets contain a surplus of phosphorus. A person may consume phosphorus in foods such as:

• meat, poultry, and fish
• dairy products
• eggs
• nuts and legumes
• grains
• vegetables

However, some people may not absorb phosphate in the intestines due to the following reasons:

• chronic diarrhea
• taking certain medications that bind phosphate, such as those that doctors prescribe for chronic kidney disease
• taking aluminum and magnesium antacids that bind phosphate

Additionally, some medical conditions may mean that a person’s body absorbs less phosphate or excretes more of it. These include:

• hyperparathyroidism
• hypoparathyroidism
• Cushing’s syndrome
• electrolyte disorders, including hypokalemia and hypomagnesemia

Genetic mutations can also decrease the amount of phosphate that the body absorbs.

Anything that increases urine production may also lead to someone losing more phosphate, for example, diuretics and alcohol.

The initial effects of hypophosphatemia are due to the lack of phosphate in the cells, and symptoms may be mild or unnoticeable.

However, if someone is deficient in phosphate long term, they may experience severe effects in the body and the following complications.

Effects on the bones

Decreased mineralization in the bones may lead to the following conditions:

• osteopenia
• osteoporosis
• rickets
• osteomalacia

Effects on the nervous system

Chronic hypophosphatemia may start to affect a person’s brain and central nervous system due to a lack of adenosine triphosphate (ATP), which the brain needs for energy. Complications and symptoms may include:

• altered mental state
• seizures
• paresthesia
• numbness
• irritability
• coma

Effects on the heart, blood, and breathing

The heart needs ATP to function, and a hypophosphatemia-induced depletion may cause the following complications:

• heart failure
• irregular heartbeat
• decreased lung and diaphragm function
• hypoventilation
• adverse effects on red and white blood cells

Effects on the gut and muscles

ATP deficiency may result in gut and muscle complications, including:

• gastrointestinal dysfunction
• difficulty swallowing or obstruction in the intestines
• muscle weakness

People with acute or chronic hypophosphatemia who are severely ill or have an alcohol use disorder may develop rhabdomyolysis. This condition occurs due to damaged muscle tissue releasing proteins and electrolytes into the blood. The condition can result in kidney injury, disability, or death.

Healthcare professionals may prescribe phosphate to a person with hypophosphatemia. The appropriate amount of phosphate depends on someone’s clinical symptoms, and doctors may administer it orally or intravenously.

Additionally, doctors may treat other medical conditions or an underlying disorder, such as thyroid disease, that affect phosphate levels.

Below are some of the most common questions and answers about hypophosphatemia.

What diseases can cause low phosphorus levels?

Thyroid diseases, electrolyte disorders, and Cushing’s syndrome may all cause low phosphate levels. Additionally, the medication that doctors prescribe for chronic kidney disease may affect phosphate levels.

Does low phosphorus make you feel tired?

Low phosphate levels may cause a person to feel weak or tired. Phosphate is involved in processes that regulate energy in a person’s body, brain, and cells.

How can someone raise their phosphorus levels?

Someone with low phosphate levels should speak with a doctor to determine the cause and to find the best treatment. This may involve a healthcare professional administering oral or intravenous phosphate.

Phosphate is essential for numerous processes in a person’s body. Abnormal levels may affect energy, the brain, the heart, or other organs and systems.

A person may not be aware of low phosphate levels and have no symptoms. People with a more severe deficiency may experience a range of symptoms and need treatment to prevent further complications. A person should speak with a healthcare professional if they think they are experiencing hypophosphatemia.