Hyperphosphatemia
Jas hyperphosphatemia we refer to plasma phosphate levels > 2.3 mmol / l in infants, 1.6 mmol / l in older children.
Etiology[edit | edit source]
It occurs as a result of increased exogenous intake or endogenous translocation (eg tumorolysis), increased intestinal absorption, decreased renal excretion or as pseudohyperphosphataemia (analytical causes).
- Hypoparathyroidism
- Pseudohypoparathyroidism
- Hypervitaminosis D
- Hyperthyroidism
- Excessive P dietary intake - dairy products
- Cell lysis syndrome
- Osteoblastic metastases
Clinical manifestations[edit | edit source]
Elevated inorganic phosphate in plasma leads to hypocalcemia and further to tetany. Increased Ca x P product in plasma induces precipitation of calcium salts in soft tissues, hypocalcemia occurs (inorganic phosphate also inhibits 1α-hydroxylation and thus reduces the production of 1,25-dihydroxyvitamin D3 → reduced absorption in the intestine). Ectopic calcification is a common complication in patients with chronic renal failure receiving vitamin D supplementation when correction for hyperphosphataemia is inadequate.
Therapy[edit | edit source]
The initial treatment is, as in the case of acute hypercalcemia, a 1/1 saline infusion of 20 ml / kg i.v. as a bolus. Our goal is hyperhydration, where we calculate the physiological daily fluid requirement as twice the norm. We co-administer furosemide 1 mg / kg i.v. and we try to keep diuresis 3-5 ml / kg / hour. We reduce the intake of protein in the diet. In the extreme case, the indication is hemodialysis.
Links[edit | edit source]
Related Articles[edit | edit source]
- Phosphate
- Hypophosphataemia
- Disorders of calcium-phosphate metabolism
- Pathophysiology of bone, calcium and phosphates
Source[edit | edit source]
- HAVRÁNEK, J .: Dysbalance of other ions .
- MASOPUST, Jaroslav and Richard PRŮŠA. Pathobiochemistry of metabolic pathways. 2nd edition. Charles University, 2004. 208 p.
