There are no national or Remedy guidelines for hypophosphataemia but Southmead’s cut off for severe hypophosphataemia requiring IV replacement is 0.32mmol/L or if patient is symptomatic
Above this level, asymptomatic patients can generally be managed with oral supplements (e.g. Phosphate Sandoz 1-2 tablets tds)
Mild hypophosphataemia 0.6 – 0.8mmol/L generally doesn’t require treatment but recheck every 2-3 days unless at risk of refeeding syndrome then recheck daily
If in doubt, or if concerns about risk of refeeding syndrome or poor absorption, discuss with Biochem consultant or AEC consultant. The Biochemistry contact details can be found here
Common causes of hypophosphataemia: hyperparathyroidism, loop diuretics, DKA, ingestion of large quantities of phosphate-binding antacids containing magnesium
and calcium, vitamin D deficiency, renal replacement therapies and excessive phosphate binders in chronic renal disease, malnutrition, refeeding syndrome.
Symptoms of hypophosphataemia: weakness, rhabdomyolysis, myopathy, acute respiratory failure, arrhythmias, cardiomyopathy, irritability, confusion, hallucinations, convulsions and coma.