In fact, epoetin-alfa and granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy have been related to hypophosphatemia.36,37 In a randomized, open label study of 30 anemic critically ill patients, hypophoshatemia was one of the most frequently reported adverse events of epoetin-alfa treatment affecting 15% of patients.36 In a phase II study of 22 patients with Richter’s syndrome or refractory lymphoproliferative disorders treated with fludarabine, cytarabine, cyclophosphamide, cisplatin and GM-CSF, hypophosphatemia was reported in 10% of patients.37. Certain natural foods, such as peas, milk, and peanut butter, also contain high levels of phosphorus. However, hyperphosphatemia may indirectly cause symptoms in two ways. Clinical features include muscle weakness, respiratory failure, and heart failure; seizures and coma can occur. More than 80% of the filtered load is reabsorbed in the proximal tubule and a small amount in the distal tubule. It is more likely that the symptoms of an underlying disease that can cause high phosphate levels, such as uncontrolled diabetes, are spotted first. Fanconi’s syndrome (FS) is characterized by impaired proximal tubular reabsorption of HCO-3, Pi, glucose, amino acids and uric acid.53 Consequently, in this setting metabolic acidosis, hypophosphatemia, hypouricemia, aminoaciduria, and/or glucosuria (in the absence of increased serum glucose levels) may be take place. Kidney disease and diabetes are common causes of hyperphosphatemia. Certain medications can increase the phosphate levels in the blood. 90 Increased intestinal absorption is generally caused by a large oral P intake 91 and a vitamin D overdose in preterm infants or an erroneous medical prescription (oral phosphate Joulie's solution instead of alkaline solution) in … Causes of Hyperphosphatemia (**main cause is Renal Failure) Remember “PhosHi” (there is a drug called Phoslo (calcium acetate) which is prescribed for patients in end stage renal failure (ESRF) to help keep phosphate levels low. Hypoparathyroidism: In this situation, there are low levels of parathyroid hormone (PTH). The safest mode of therapy is oral given that overzealous intravenous phosphate therapy for hypophosphatemia has been reported to cause a precipitous fall in serum calcium concentration resulting in tetany, hypotension, renal failure and potentially fatal arrhythmias.95–97 Phosphate salts are available in skim milk (∼1g/l). Hypophosphatemia due to the movement of Pi from the extracellular to intracellular compartment is common. Herein, we review the clinical information of hypophosphatemia associated with specific drug treatment and discuss the underlying pathophysiology. Vomiting 6. Diagnosis. Internal Pi redistribution due to hyperventilation and dextrose infusion as well as increased renal phosphate loss because of a reduction of the renal threshold for tubular phosphate reabsorption have been proposed.87–89, It has been suggested that processes involved in hepatic regeneration might lead to hypophosphatemia, where as acetaminophen-related hyperphosphatemia is likely caused by renal dysfunction in the absence of hepatic regeneration.90, Parenteral iron administration has been implicated as a cause of hypophosphatemia possibly by reducing renal phosphate reabsorption and inhibiting the 1-a hydroxylation of vitamin D. It has been suggested that this hypophosphatemic effect is mediated by an increase in the phosphatonin FGF-23 probably due to iron-related inhibition of enzymatic cleavage of intact FGF-23.91,92 Moreover, iron-related increased renal phosphate losses could be ascribed to a direct toxic effect of iron on renal tubules.93,94. Those who have had kidney failure and are having dialysis are most at risk. Kidney dialysis also removes some phosphates from the blood. (A) Summary of phosphate (Pi) metabolism for a normal adult in neutral phosphate balance. Finally, inappropriate phosphaturia may play a role in the pathogenesis of hypophosphatemia. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. Hypophosphatemia-related to drug-treatment can be caused by several medications. 1. The critical role phosphate plays in every cell, tissue and organ explains the systemic nature of injury caused by phosphate deficiency. An X-ray may be needed if a person has symptoms of mineral and bone disorder. A person with an underlying condition linked to hyperphosphatemia may wish to avoid these foods. Drugs used to treat Hyperphosphatemia of Renal Failure The following list of medications are in some way related to, or used in the treatment of this condition. Hyperphosphatemia Medications. In more severe cases, concomitant hypocalcemia may result from precipitation of excessive phosphorus with calcium and cause … They also decrease calcium resorption in the gut. The doctor will insert a needle into a vein in the arm and take a small sample of blood that will be sent to a laboratory for testing. Good health helps people live a full life…, © 2004-2021 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Beyond foods and drinks, medications may be a significant source of phosphate that adds to patients’ daily load. Hypophosphatemia resulting from more than one mechanism, Drug-induced metabolic acidosis (alcohol, toluene), Drugs that cause vitamin D deficiency or resistance: phenytoin, phenobarbital, Anticancer drugs: ifosfamide, streptozocin, azacitidine, suramin, Antibiotics: tetracyclines, aminoglycosides, Antiviral agents:cidofovir, adefovir, tenofovir, Copyright © 2021 Association of Physicians of Great Britain and Ireland. If a person has uncontrolled diabetes, it is essential to bring this under control with diet, exercise, and a medicine called insulin. Therefore, without enough PTH there is more reabsorption of the phosphate leading to a high phosphate level in the blood. In this article, we discuss the pros and cons of growing and eating genetically modified organisms…. Association of suramin with mitochondrial toxicity in humans, Ifosfamide-induced nephrotoxicity in 593 sarcoma patients: a report from the Late Effects Surveillance System, Development of ifosfamide-induced nephrotoxicity: prospective follow-up in 75 patients, Risk factors for ifosfamide nephrotoxicity in children, Long-term evaluation of ifosfamide-related nephrotoxicity in children, Risk factors for long-term outcome of ifosfamide-induced nephrotoxicity in children, Ifosfamide nephrotoxicity in pediatric cancer patients, Efficacy and safety of adefovir dipivoxil with antiretroviral therapy: a randomized controlled trial, Tetracycline-induced renal hypophosphatemia in a patient with a syndrome of inappropriate secretion of antidiuretic hormone, Aminoglycoside-induced reversible tubular dysfunction, Anticonvulsants as a cause of Fanconi syndrome, Longterm treatment of psoriasis using fumaric acid preparations can be associated with severe proximal tubular damage, The effect of long-term mestranol administration on calcium and phosphorus homeostasis in oophorectomized women, Estramustine affects bone mineral metabolism in metastatic prostate cancer, Decreased serum phosphate levels after high-dose estrogens in metastatic prostate cancer. When kidney disease causes hyperphosphatemia, a combination of changes to diet and medication is usually used to treat it. It is rare for the acute cases to create long-standing problems as these are most commonly caused by adolescent growth spikes. Dialysis, often used to treat kidney dysfunction, is not very effective at removing phosphate and thus does not reduce the risk of hyperphosphatemia. Nausea 5. Reducing available phosphate may compromise any organ system, alone or in combination. Of those, 47 (77.4%) also received cisplatin.64 On the other hand, the incidence of hypophosphatemia related to moderate dose of ifosfamide may be as low as 1%.62, Antiviral medications including cidofovir, tenofovir, and more often, adefovir can induce hypophosphatemia due to FS. Increased urinary phosphate excretion. Typically, people with kidney failure have their phosphate levels regularly monitored, which means that hyperphosphatemia will usually be found during routine checks. 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