Are you studying hypophosphatemia and need to know some mnemonics on how to remember the causes, signs & symptoms, nursing interventions? This article will give you some clever mnemonics on how to remember hypophosphatemia for nursing lecture exams and NCLEX.
In addition, you will learn how to differentiate hypophosphatemia from hyperphosphatemia. Don’t forget to take the hypophosphatemia and hyperphosphatemia quiz.
In this article you will learn:
Normal Phosphate Level
Causes of Hypophosphatemia
Signs & Symptoms of Hypophosphatemia
Nursing Interventions for Hypophosphatemia
Teaching Tutorial on Hypophosphatemia
Hypophosphatemia
Hypo: “below”
Phosphat: prefix for phosphate
Emia: blood
Meaning of Hypophosphatemia: Low levels of phosphate in the blood
Normal Phosphate levels: 2.7 to 4.5 mg/dL (<2.7 is hypophosphatemia)
Role of phosphate in the body: helps build bones/teeth and nerve/muscle function.
Stored mainly in the bones. The kidneys and parathyroid play a role in the regulation of calcium and phosphate.
**Calcium and phosphate influence each other in opposite way. For example, when calcium levels increase in turn phosphate levels decrease (vice versa).
Vitamin D plays an important role in phosphate absorption.
Causes of Hypophosphatemia
Remember phrase: Low “Phosphate”
Pharmacy: drugs such as aluminum hydroxide-based or magnesium based antacids cause malabsorption in the GI system, so no phosphate is absorbed through the GI track and the lack of vitamin d (which plays a role in phosphate absorption).
Hyperparathyroidism: due to over secretion of parathyroid hormone (parathyroid plays a role in maintaining calcium and phosphate levels and it normally inhibits re-absorption of phosphate by the kidneys). However, in hyperparathyroidism there is an over secretion of PTH which causes phosphate to NOT be reabsorbed at all.
Oncogenic osteomalacia: kidneys start to waste phosphate which leads to low phosphate levels and softening of the bones (this puts the patient at risk for bone fractures).
Syndrome of Refeeding (aka Refeeding Syndrome): causes electrolytes and fluid problems due to malnutrition or starvation.
**Watch patients who are on TPN (total parenteral nutrition). This happens when food is reintroduced after the body being in starvation mode (hence the body went into survival mode and is depleted of almost everything). When the nutrition is introduced, the body releases insulin due to the increased blood sugar from the food which causes the body to rapidly use the already low stores of phosphate, magnesium, and potassium to help with synthesizing. This depletes phosphate levels.
Pulmonary issues such as respiratory alkalosis (under alkalotic conditions phosphate moves out of the blood into the cell which causes phosphate blood levels to decrease)
Hyperglycemia leads to symptoms of glycosuria, polyuria, ketoacidosis which causes the kidneys to waste phosphate
Alcoholism: alcohol affects the body’s ability to absorb phosphate and many alcoholics are already malnourished (hence already have low phosphate level to begin with)
Thermal Burns due to the shifting of phosphate intracellularly
Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia also cause phosphate levels to decrease
Signs & Symptoms of Hypophosphatemia
Remember the word: “BROKEN”
These patients are at risk for broken bones and the systems of the body are breaking down (respiratory, muscles, neuro, immune etc.)
Breathing problems due to muscle weakness
Rhabdomyolysis which is caused by an electrolyte disorder. This happens when there is rapid necrosis of the skeletal muscles which leads to renal failure. **These patients will have tea-colored looking urine due to myoglobin in the urine and will have muscle weakness/pain. The renal failure occurs because when the muscle dies, myoglobin is released into the blood which is very toxic to the kidneys. Reflexes (deep tendon) decreased
Osteomalacia (softening of the bones) fractures and decreased bone density (alteration in bone shape), cardiac Output decreased
Kills immune system with immune suppression and decreases platelet aggregation (which leads to increased bleeding)
Extreme weakness, Ecchymosis from decreased platelets
Neuro status changes (irritability, confusion, seizures)
Nursing Interventions for Hypophosphatemia
**Administer oral phosphorus with Vitamin-D supplement (remember vitamin-d helps with absorbing phosphate)
If patient is receiving TPN watch for patient complaints of muscle pain or weakness (may be due to rhabdomyolysis or refeeding syndrome)
Ensure patient safety due to risk of bone fractures
Encourage foods high is phosphate but low in calcium: **Foods high in phosphate are fish, organ meats, nuts, pork, beef, chicken, whole grains
If phosphate levels less than 1mg/dL, the doctor may order IV phosphorous which affects calcium levels causing hypocalcemia or increase phosphate levels (Hyperphosphatemia). ***Also, assess renal status (BUN/creatintine normal) before administering phosphorous because if the kidneys are failing the patient won’t be able to clear phosphate). Place on cardiac monitor and watch for EKG changes.