Muzamil Shahzad, Amir Iqbal, Tariq Hussain Khatak.
To identify the prevalence of hypophosphatemia in critically ill patients.
Pak J Med Health Sci Jan ;4(4):366-9.

Phosphorus plays an important part in metabolism as a main intracellular anion, enzyme constituent, and component of phosphorylated intermediate compounds, and phosphorus is also a component in cellular membranes, nucleic acids, and nuclear proteins. Hypophosphatemia is the most neglected electrolyte deficiency in our medical practice. A number of clinical conditions and drugs can cause hypophosphatemia. Transient hypophosphatemia seldom causes symptoms but severe hypophosphatemia may contribute to increased morbidity and mortality in seriously ill patients. Fifty critically ill patients were admitted in medical unit and intensive care unit over a period of six months in the study. The mean age was 49.5±17.4. Thirty one (62%) patients were male and 19 (38%) were female. During hospital admission, sixteen (16%) patients had hypophosphatemia (<2.5mg/dl), eighty four (84%) had either normal phosphate levels or hyperphosphatemia. The mean phosphate concentration was 3.27±0.79mg/dl (range 1.8 to 5.1mg/dl). The prevalence of hypophosphatemia was comparable with the international studies. Important clinical diagnosis with hypophosphatemia in our study were diabetic ketoacidosis (16%), respiratory alkelosis (18%), septicemia (32%), chronic obstructive pulmonary disease (32%), respiratory failure (42%), hepatic coma (38%), renal failure (10%). Patients presenting with shortness of breath had higher frequency of hypophosphatemia (p=.047). Patients receiving ß2-agnosists had low serum phosphate levels though it was statistically insignificant while patients with renal failure had higher level of serum phosphate. Prevalence of hypophosphatemia was higher in patients with more than one disease. Mortality among hypophosphatemic patients with septicemia was higher (32%). Ninteen (38%) received mechanical ventilation had hypophosphatemia, hepatic coma and respiratory alkeolosis were present in 60% of patients. Serum calcium and serum albumin levels were low in patients of hypophosphatemia. Severe hypophosphatemia (<1.5mg/dl) was not observed in this study. Haemoglobin levels were not affected significantly below serum phosphate levels. The prevalence of hypophosphatemia was higher in patients admitted with shortness of breath. The hypophosphatemia was 15% in critically ill patients admitted in Medical and ICU Units. Patients with septicemia, respiratory failure and chronic obstructive pulmonary diseases were more prone to develop hypophosphatemia.

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