Hostname: page-component-7bb8b95d7b-lvwk9 Total loading time: 0 Render date: 2024-09-21T17:51:07.856Z Has data issue: false hasContentIssue false
  • English
  • Français

Serum phosphate in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  21 December 2009

M Lambert ,
MD Witham  and
D Sumukadas
M Lambert
Affiliation:
Department of Medicine for the Elderly, NHS Tayside
MD Witham
Affiliation:
Ageing & Health, Division of Medical Sciences, University of Dundee
D Sumukadas*
Affiliation:
Department of Medicine for the Elderly, NHS Tayside
*
Address for correspondence: Dr Deepa Sumukadas, Ageing & Health, Mailbox 1, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK. Email: d.sumukadas@nhs.net
Get access Rights & Permissions [Opens in a new window]

Summary

Phosphate (PO4−) has a number of important functions in the human body and abnormalities of phosphate handling and phosphate levels are common in older people. We review the physiological functions of phosphate, the effects of phosphate deficiency and excess, and discuss the evidence underpinning management of these conditions in older people. Both hyper- and hypophosphataemia have been associated with a variety of adverse effects in different patient groups. There is currently little evidence to guide practice in treatment of abnormal phosphate levels specifically in older people. Studies looking into the effect of replacing phosphate on morbidity and mortality in milder cases of hypophosphataemia and into the dangers of, and treatment of, hyperphosphataemia in older people are required.

Keywords

Hypophosphataemiahyperphosphataemiaaged
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 4 , November 2009 , pp. 263 - 270
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Dumartheray, EW, Krieg, MA, Cornuz, J, Whittamore, DR, Lanham-New, SA, Burckhardt, P. Energy and nutrient intake of Swiss women aged 75–87 years. J Hum Nutr Diet 2006; 19: 431–35.CrossRefGoogle ScholarPubMed
2Payette, H, Roubenoff, R, Jacques, PF et al. Insulin-like growth factor-1 and interleukin 6 predict sarcopenia in very old community-living men and women: the Framingham Heart Study. J Am Geriatr Soc 2003; 51: 1237–43.CrossRefGoogle ScholarPubMed
3Cirillo, M, Ciacci, C, De Santo, NG. Age, renal tubular phosphate reabsorption, and serum phosphate levels in adults. N Engl J Med 2008; 359: 864–66.CrossRefGoogle ScholarPubMed
4Larsson, L, Rebel, K, Sorbo, B. Severe hypophosphate – a hospital survey. Acta Med Scand 1983; 214: 221–23.CrossRefGoogle Scholar
5Haglin, L, Burman, LA, Nilsson, M. High prevalence of hypophosphataemia amongst patients with infectious diseases. A retrospective study. J Intern Med 1999; 246: 45–52.CrossRefGoogle ScholarPubMed
6Halevy, J, Bulvik, S. Severe hypophosphatemia in hospitalized patients. Arch Intern Med 1988; 148: 153–55.CrossRefGoogle ScholarPubMed
7Kagansky, N, Levy, S, Koren-Morag, N, Berger, D, Knobler, H. Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival. J Intern Med 2005; 257: 461–68.CrossRefGoogle ScholarPubMed
8Sumukadas, D, Jenkinson, F, Witham, MD. Associations and consequences of hypophosphataemia in older hospitalised women. Age Ageing 2009; 38: 112–15.CrossRefGoogle ScholarPubMed
9Marinella, MA. Refeeding syndrome: an important aspect of supportive oncology. J Support Oncol 2009; 7: 11–16.Google ScholarPubMed
10Marvin, VA, Brown, D, Portlock, J, Livingstone, C. Factors contributing to the development of hypophosphataemia when refeeding using parenteral nutrition. Pharm World Sci 2008; 30: 329–35.CrossRefGoogle Scholar
11Marik, PE, Bedigian, MK. Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch Surg 1996; 131: 1043–47.CrossRefGoogle Scholar
12Elisaf, M, Theodorou, J, Pappas, H, Siamopoulos, KC. Acid–base and electrolyte abnormalities in febrile patients with bacteraemia. Eur J Med 1993; 2: 404–7.Google ScholarPubMed
13Amanzadeh, J, Reilly, RF Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol 2006; 2: 136–48.CrossRefGoogle ScholarPubMed
14Megarbane, B, Guerrier, G, Blancher, A, Meas, T, Guillausseau, PJ, Baud, FJ. A possible hypophosphatemia-induced, life-threatening encephalopathy in diabetic ketoacidosis: a case report. Am J Med Sci 2007; 333: 384–86.CrossRefGoogle ScholarPubMed
15Funabiki, Y, Tatsukawa, H, Ashida, K et al. Disturbance of consciousness associated with hypophosphatemia in a chronically alcoholic patient. Intern Med 1998; 37: 958–61.CrossRefGoogle Scholar
16Zazzo, JF, Troche, G, Ruel, P, Maintenant, J. High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Intensive Care Med 1995; 21: 826–31.CrossRefGoogle Scholar
17Fisher, J, Magid, N, Kallman, C et al. Respiratory illness and hypophosphatemia. Chest 1983; 83: 504–8.CrossRefGoogle ScholarPubMed
18Shor, R, Halabe, A, Rishver, S et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci 2006; 36: 67–72.Google ScholarPubMed
19Gravelyn, TR, Brophy, N, Siegert, C, Peters-Golden, M. Hypophosphatemia-associated respiratory muscle weakness in a general inpatient population. Am J Med 1988; 84: 870–76.CrossRefGoogle Scholar
20Nava, S, Fuccella, LM, Viglianti, B. Physiological effects of intravenous fructose 1,6-diphosphate on diaphragmatic function in malnourished patients with COPD. Monaldi Arch Chest Dis 2004; 61: 203–8.CrossRefGoogle ScholarPubMed
21Marchesani, F, Valerio, G, Dardes, N, Viglianti, B, Sanguinetti, CM. Effect of intravenous fructose 1,6-diphosphate administration in malnourished chronic obstructive pulmonary disease patients with chronic respiratory failure. Respiration 2000; 67: 177–82.CrossRefGoogle ScholarPubMed
22Terlevich, A, Hearing, SD, Woltersdorf, WW et al. Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor. Aliment Pharmacol Ther 2003; 17: 1325–29.CrossRefGoogle ScholarPubMed
23Clark, CL, Sacks, GS, Dickerson, RN, Kudsk, KA, Brown, RO. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med 1995; 23: 1504–11.CrossRefGoogle ScholarPubMed
24Taylor, BE, Huey, WY, Buchman, TG, Boyle, WA, Coopersmith, CM. Treatment of hypophosphatemia using a protocol based on patient weight and serum phosphorus level in a surgical intensive care unit. J Am Coll Surg 2004; 198: 198–204.CrossRefGoogle Scholar
25Knobel, B, Petchenko, P. Hyperphosphatemic hypocalcemic coma caused by hypertonic sodium phosphate (fleet) enema intoxication. J Clin Gastroenterol 1996; 23: 217–19.CrossRefGoogle ScholarPubMed
26Carl, I, Mitchell, M. Symptomatic hyperphosphataemia following phosphate enema in a healthy adult. Ulster Med J 2007; 76: 172–73.Google Scholar
27Hsu, HJ, Wu, MS. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. Intern Med 2008; 47: 643–46.CrossRefGoogle ScholarPubMed
28Gumurdulu, Y, Serin, E, Ozer, B, Gokcel, A, Boyacioglu, S. Age as a predictor of hyperphosphatemia after oral phosphosoda administration for colon preparation. J Gastroenterol Hepatol 2004; 19: 68–72.CrossRefGoogle ScholarPubMed
29Chonchol, M, Dale, R, Schrier, RW, Estacio, R. Serum phosphorus and cardiovascular mortality in type 2 diabetes. Am J Med 2009; 122: 380–86.CrossRefGoogle ScholarPubMed
30Tonelli, M, Sacks, F, Pfeffer, M, Gao, Z, Curhan, G. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation 2005; 112: 2627–33.CrossRefGoogle ScholarPubMed
31Dhingra, R, Sullivan, LM, Fox, CS, Wang, TJ et al. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 2007; 167: 879–85.CrossRefGoogle Scholar
32Foley, RN, Collins, AJ, Ishani, A, Kalra, PA. Calcium-phosphate levels and cardiovascular disease in community-dwelling adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 2008; 156: 556–63.CrossRefGoogle ScholarPubMed
33Onufrak, SJ, Bellasi, A, Shaw, LJ et al. Phosphorus levels are associated with subclinical atherosclerosis in the general population. Atherosclerosis 2008; 199: 424–31.CrossRefGoogle ScholarPubMed
34Giovannucci, E, Liu, Y, Hollis, BW, Rimm, EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 2008; 168: 1174–80.CrossRefGoogle Scholar
35Watson, KE, Abrolat, ML, Malone, LL et al. Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation 1997; 96: 1755–60.CrossRefGoogle ScholarPubMed
36Park, W, Kim, BS, Lee, JE et al. Serum phosphate levels and the risk of cardiovascular disease and metabolic syndrome: a double-edged sword. Diabetes Res Clin Pract 2009; 83: 119–25.CrossRefGoogle ScholarPubMed
37Kalaitzidis, R, Tsimihodimos, V, Bairaktari, E, Siamopoulos, KC, Elisaf, M. Disturbances of phosphate metabolism: another feature of metabolic syndrome. Am J Kidney Dis 2005; 45: 851–58.CrossRefGoogle ScholarPubMed
38Onufrak, SJ, Bellasi, A, Cardarelli, F et al. Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality. Am J Epidemiol 2009; 169: 67–77.CrossRefGoogle ScholarPubMed
39Shinaberger, CS, Greenland, S, Kopple, JD et al. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Am J Clin Nutr 2008; 88: 1511–18.CrossRefGoogle ScholarPubMed
40Calvo, MS, Park, YK. Changing phosphorus content of the U.S. diet: potential for adverse effects on bone. J Nutr 1996; 126 (4 suppl): 1168–80S.CrossRefGoogle ScholarPubMed
41Kemi, VE, Rita, HJ, Karkkainen, MU et al. Habitual high phosphorus intakes and foods with phosphate additives negatively affect serum parathyroid hormone concentration: a cross-sectional study on healthy premenopausal women. Public Health Nutr 2009; 12 1885–92.CrossRefGoogle ScholarPubMed
42Pinheiro, MM, Schuch, NJ, Genaro, PS, Ciconelli, RM, Ferraz, MB, Martini, LA. Nutrient intakes related to osteoporotic fractures in men and women – the Brazilian Osteoporosis Study (BRAZOS). Nutr J 2009; 8: 6.CrossRefGoogle ScholarPubMed