VA Report Pearls: Hypophosphatemia

Take Home Point:
The major causes of hypophosphatemia include:
– increased cellular uptake (transcellular shifts)
– increased urinary excretion
– decreased intestinal absorption

The cause of hypophosphatemia can often be determined with a good history. However, when the etiology of hypophosphatemia is unclear, the next diagnostic step is to measure urinary phosphate excretion. This can be done with a 24-hour urine collection or a calculation of the fractional excretion of phosphate (FEPO4) from a random urine sample.

See the picture below for a full diagnostic algorithm.


Assadi F. Hypophosphatemia: An evidence-based problem-solving approach to clinical cases. Iranian Journal of Kidney Diseases. 2010;4:195-201.

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