Why is Phosphorous Important

Why is phosphorous important? Phosphate plays an important role in vital cell functions including ATP production however, abnormalities in phosphate levels are usually very well tolerated. Risk factors for hypophosphatemia include DKA, malnutrition (including alcoholism), sepsis and diuretic or antacid therapy. Signs and symptoms of hypophosphatemia are usually only seen in severe hypophosphatemia and include myocardial depression, respiratory insufficiency, generalized weakness and seizure. All of these symptoms are due to decreased efficiency in energy production (ATP) on the cellular level. In the case of symptomatic hypophosphatemia, phosphate should be replaced slowly over time and can be replaced orally or intravenously. Hyperphosphatemia is rare in patients with normal renal function because extra phosphate is easily excreted by the kidneys. Clinical signs of hyperphosphatemia manifest when excess serum phosphate binds with calcium and is precipitated within the tissues resulting in hypocalcemia. These signs include soft tissue deposition of calcium phosphate crystals and signs of hypocalcemia including paresthesias, hyperreflexia, tetany and myocardial depression. Treatment includes hydration with normal saline which facilitates phosphate excretion by the kidneys and administration of glucose and insulin which drives phosphate from the serum into the cells. Overall, abnormalities in phosphate are rarely an emergency that must be addressed in the emergency department but can become important later especially in seriously ill, ICU level patients.