Are these GP patients or patients in a hospital or just admitted to the hospital and maybe on IV dextrose?
Do you know the body mass index of these cases?
As Jonathan pointed it out, refeeding syndrome is not uncommon in hospital setting and such low PO4 is ususally associated with refeeding or simple iv dextrose given to malnourished patients. The one with 0.12 mmol/L must feel pretty bad clinically too - do you know what other symptoms that patient has?
How about the other electrolytes, i.e. Ca, Mg, K, and their admission or if out-patient fasting glucose?
Could this only be alcohol intox or use of some recreational drugs as most patients you refer to seem to be very young. The below review also says:
"Metabolic acidosis (namely, alcoholic ketoacidosis) is one of the possible underlying mechanisms of alcohol-related hypophosphatemia. It has also been reported that sniffing of toluene can cause distal tubular acidosis and hypophosphatemia"
Some publications might be helpful regarding medication induced hypophosphataemias:
http://qjmed.oxfordjournals.org/content/103/7/449.full - this is the review I quoted above
http://www.rightdiagnosis.com/h/hypophosphatemia/medic.htm
Best regards, Rita
________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Wytze Oosterhuis [[log in to unmask]]
Sent: Wednesday, 27 February 2013 1:19 AM
To: [log in to unmask]
Subject: Betr.: Low In Phos
Some antacids can bind phosphate and cause hypophospatemia and osteomalacia:
Calcif Tissue Int.<http://www.ncbi.nlm.nih.gov/pubmed/2257522> 1990 Nov;47(5):291-5.
Antacid and sucralfate-induced hypophosphatemic osteomalacia: a case report and review of the literature.
Chines A<http://www.ncbi.nlm.nih.gov/pubmed?term=Chines%20A[Author]&cauthor=true&cauthor_uid=2257522>, Pacifici R<http://www.ncbi.nlm.nih.gov/pubmed?term=Pacifici%20R[Author]&cauthor=true&cauthor_uid=2257522>.
>>> "[log in to unmask]" <[log in to unmask]> 2/26/2013 2:32 >>>
At the moment we are seeing an increased number of patients presenting with abdominal pain with low PO4 results. This morning I have 2 young male patients one with PO4 0.12 the other 0.3 mmol/L.
Is this a local phenomenon?
David
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