Hyperphosphatemia

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Hyperphosphatemia is an abnormal health condition that is seen in about 3% of the general population. Read on to know all about this disorder as well as its causes, symptoms, diagnosis and treatment.

What is Hyperphosphatemia?

It is a condition marked by an unusually high level of phosphates in the bloodstream. Generally, the phosphate level is significantly higher than the usual range of 0.84 to 1.58 mmol in each liter of serum.

Hyperphosphatemia Symptoms

Some of the main symptoms of Hyperphosphatemia are :

Secondary Hyperparathyroidism (SHPT)

It makes the Parathyroid glands secrete excessive Parathyroid hormone (PTH) as a response to Hypocalcemia (low calcium levels in bloodstream) as well as associated hypertrophy of the glands. This condition is particularly seen in individuals suffering from Chronic Renal Failure. The hormone mobilizes calcium from the bones and increases its concentration in the bloodstream. If this condition persists, it may result in discomforting symptoms like

  • Pain and fractures due to acute bone weakness
  • Crystallization of calcium and phosphate in the heart, wall of the vessels and in the bloodstream
  • Acute arteriosclerosis (hardening of the arteries)
  • Poor circulation
  • Strokes
  • Heart attacks

Renal Osteodystrophy

It is a bone disorder that is marked by fibrous degeneration and softening of bone as well as the development of cysts in bone tissue. It results from Chronic Renal Failure.

Ectopic calcification

It refers to a pathologic calcium salt deposition in the tissues.

Hyperphosphatemia may also lead to the accumulation of crystals in the skin of a person, resulting in acute itchiness. Acute hyperphosphatemia usually result in the sudden development of problems like :

  • Tetany – It is a neurological syndrome that is marked by seizures as well as cramps and twitching sensations in the muscles.
  • Hypocalcemia – It is characterized by unusually low amount of calcium in the bloodstream of a suffering individual.
  • Ectopic or metastatic calcification – It results from pathologic calcium salt deposition in tissues that were previously undamaged.

Hyperphosphatemia Causes

Some of the main causes of Hyperphosphatemia are:

Impaired kidney function

Defective function of the kidneys is one of the most common causes of this disorder. An impairment of kidney function can make it difficult to eliminate certain salts from the bloodstream.

Hypoparathyroidism

This disorder is characterized by reduced level of Parathyroid hormone (PTH). Usually, this hormone suppresses reabsorption of phosphate by the kidneys. In the absence of enough PTH, the reabsorption of phosphate is higher.

Chronic renal failure

A chronic failure of the kidneys results in higher retention of phosphate in the human body. This leads to Hyperphosphatemia.

Osteomalacia

This condition is supposed to arise from insufficient vitamin D in the diet as well as other factors like malabsorption, renal disorders or lack of sunlight. It may also be a causative condition for this disorder.

Drugs

Oral Sodium Phosphate solutions are used to prepare bowels of children prior to Colonoscopy. Oral intake of these solutions can lead to the development of Hyperphosphatemia.

Phosphate levels can also increase due to use of certain medications and some childhood disorders. Too much phosphate may also lead to an imbalance of electrolytes in the bloodstream. This occurs as the body finds it difficult to correct the problem rapidly with fresh electrolytes being introduced constantly.

Hyperphosphatemia Differential Diagnosis

The differential diagnosis of this condition involves differentiating it from discomforting symptoms arising out of

  • Imbalance or excess in diet
  • Toxins
  • Lipemia
  • Icterus
  • Hemolysis
  • Physiologic hyperphosphatemia in animals of young age

Hyperphosphatemia Treatment

The first step in curing Hyperphosphatemia is to determine the condition causing it. Once the cause is diagnosed, cure or management can begin while caregivers work on bringing stability in the electrolyte levels of the patient. This can be done by encourage elimination of waste products through the kidneys by using a diuretic and supplemental water.

Patients having this condition as a result of kidney injury can be cured by reducing the absorption of phosphate from gastrointestinal tract as well as lowering its intake. Sufferers must avoid food items that are rich in phosphate content. Antacids comprising of calcium must be taken along with meals to make the calcium bind to the intestinal phosphates and not get absorbed. Prolonged stimulation of parathyroid glands can lead to Hyperparathyroidism, making surgical removal of glands necessary.

Treatment for acute Hyperphosphatemia involves administering phosphate binding salts such as Aluminum, Magnesium and Calcium. However aluminum is not administered in patients with renal failure. This is because there can be a deposition of Aluminum. It is preferable to use Calcium in such cases.

Reduced dietary intake of phosphate and Phosphate Binders can help avoid increase of this salt in the bloodstream. Moderate exercise and drinking lots of fluids can help one get rid of imbalance in the bloodstream by utilizing excess phosphates. If these methods are found inadequate in improving the situation, doctors may use binding agents.

Hyperphosphatemia Prevention

Individuals suffering from disorders causing this condition are at high risk of suffering from Hyperphosphatemia. They should be regularly screened with the aid of blood tests and a complete electrolyte panel. This can allow care providers to detect problems quickly, before non-treatment results in complications. This disease may also be diagnosed while a routine blood panel is being carried out for identifying other conditions.

Hypercalcemia and Hyperphosphatemia

An overactive parathyroid gland (Hyperparathyroidism) is often responsible for the development of both Hypercalcemia and Hyperphosphatemia in the same individual. Hyperparathyroidism results in excessive secretion of Parathyroid hormone which results in an unusually high level of calcium in the human bloodstream. This can have an impact on many systems of the human body, particularly resulting in Osteoporosis and Bone Resorption.

Vitamin D toxicosis is also responsible for inducing both Hypercalcemia and Hyperphosphatemia.

Hyperphosphatemia is seen as serious when the level of Phosphate is greater than 7 mg/dL in children as well as adolescents and 5 mg/dL in adults. In a normal adult, the range is 0.81-1.45 mmol/L (2.5-4.5 mg/dL). Phosphate levels are 30% higher in children and 50% greater in infants due to effects of growth hormone.

References:

http://emedicine.medscape.com/article/767010-overview

http://www.unitedhealthdirectory.com/diseases-and-conditions/hyperphosphatemia/

http://www.ccmtutorials.com/misc/phosphate/page_08.htm

http://www.uptodate.com/contents/causes-and-treatment-of-hyperphosphatemia

http://www.jaapa.com/hyperphosphatemia-understanding-the-role-of-phosphate-metabolism/article/173478/

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