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The Clinical Syndrome of Phosphate Depletion

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Homeostasis of Phosphate and Other Minerals

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 103))

Abstract

There are 600–700 grams of phosphorus in the human body, with 85% of it in the skeleton. Only 600–700 mg or 1/1000 of total body phosphorus is found in the extracellular fluid. About 15% of body phosphorus is located in soft tissues, mainly in the form of intermediary carbohydrate, lipid and protein compounds. The amount of inorganic phosphorus in the cell is very small, but it is very important since it is this fraction which provides the source of phosphorus for the resynthesis of adenosine triphosphate, ATP, (1).

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References

  1. Krebs, H.: Rate limiting factors in cell respiration. CIBA Foundation Symposium on Regulation of Cell Metabolism. Little, Brown Publishers, Boston, pp. 1–10, 1959.

    Google Scholar 

  2. Betro, M.G., and Pain, R.W.: Hypophosphatemia and hyperphosphatemia in a hospital population. Brit. Med. J. 1: 273, 1972.

    Article  PubMed  CAS  Google Scholar 

  3. Stein, J.H., Smith, W.O., and Ginn, E.: Hypophosphatemia in acute alcoholism. Am. J. Med. Sci. 252: 78, 1966.

    Article  PubMed  CAS  Google Scholar 

  4. Bloom, W.L., and Flinchum, D.: Osteomalacia with pseudo- fractures caused by the ingestion of aluminum hydroxide. JAMA 174: 1327, 1960.

    Google Scholar 

  5. Lotz, M., Ney, R., and Bartter, F.C.: Osteomalacia and debility resulting from phosphorus depletion. Trans. Assoc. Amer. Physicians, 77: 281, 1964.

    CAS  Google Scholar 

  6. Abrams, D.E., Silcott, R.B., Terry, R., Berne, T.V., and Barbour, B.H.: Antacid induction of phosphate depletion syndrome in renal failure. Western J. Med. 120: 157, 1974.

    CAS  Google Scholar 

  7. Rapoport, S., Stevens, C.D., Engel, G.L., Ferris, E.P., and Logan, M.: The effect of voluntary overbreathing on the electrolyte equilibrium of arterial blood in man. J. Biol. Chem. 163: 411, 1946.

    PubMed  CAS  Google Scholar 

  8. Okel, B.B., and Hurst, J.W.: Prolonged hyperventilation in man. Associated electrolyte changes and subjective symptoms. Arch. Intern. Med. 108: 757, 1961.

    Article  PubMed  CAS  Google Scholar 

  9. Mostellar, M.E., and Tuttle, E.P., Jr.: The effects of alkalosis on plasma concentration and urinary excretion of inorganic phosphate in man. J. Clin. Invest. 43: 138, 1964.

    Article  PubMed  CAS  Google Scholar 

  10. Franks, M., Berris, R.F., Kaplan, N.O., and Myers, G.P.: Metabolic studies in diabetic acidosis. I. The effect of early administration of dextrose. Arch. Intern. Med. 80: 739, 1947.

    Article  CAS  Google Scholar 

  11. Franks, M., Berris, R.F., Kaplan, N.O., Myers, G.P.: Metabolic studies in diabetic acidosis. II. The effect of the administration of sodium phosphate. Arch. Intern. Med. 81: 42, 1948.

    Article  CAS  Google Scholar 

  12. Silvis, S.E., and Paragas, P.D., Jr.: Fatal hyperalimentation syndrome. Animal studies. J. Lab. Clin. Med. 78: 918, 1971.

    PubMed  CAS  Google Scholar 

  13. Silvis, S.E., and Paragas, P.D., Jr.: Parasthesias, weakness, seizures and hypophosphatemia in patients receiving hyperalimentation. Gastroenterol. 62: 513, 1972.

    CAS  Google Scholar 

  14. Lichtman, M.A., Miller, D.R., and Freeman, R.B.: Erythrocyte adenosine triphosphate depletion during hypophosphatemia in a uremic subject. N. Engl. J. Med. 280: 240, 1969.

    Article  PubMed  CAS  Google Scholar 

  15. Lichtman, M.A., Miller, D.R., Cohen, J., Waterhouse, C.: Reduced red cell glycolysis, 2,3-diphosphoglycerate and adenosine triphosphate concentration, and increased oxygen affinity caused by hypophosphatemia. Ann. Intern. Med. 74: 562, 1971.

    PubMed  CAS  Google Scholar 

  16. Travis, S.F., Sugarman, H.J., Rubergy, R.L., Dudrick, S.J., Delivoria-Papadopoulos, M., Miller, L.D., and Oski, F.A.: Alterations of red cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation. N. Engl. J. Med. 285: 763, 1971.

    Article  PubMed  CAS  Google Scholar 

  17. Jacob, H.S., and Amsden, T.: Acute hemolytic anemia with rigid red cell hypophosphatemia. N. Engl. J. Med. 285: 1446, 1971.

    Article  PubMed  CAS  Google Scholar 

  18. Klock, J.C., Williams, H.E., Mentzer, W.C.: Hemolytic anemia and somatic cell dysfunction in severe hypophosphatemia. Arch. Intern. Med. 134: 360, 1974.

    Article  PubMed  CAS  Google Scholar 

  19. Territo, M.D., and Tanaka, K.R.: Hypophosphatemia in chronic alcoholism. Arch. Intern. Med. 134: 445, 1974.

    Article  PubMed  CAS  Google Scholar 

  20. Craddock, P.R., Yawata, Y., Van Santen, L., Silverstadt, S., Silvis, S., and Jacob, H.S.: Acquired phagocyte dysfunction. A complication of the hypophosphatemia of parenteral hyper-alimentation. N. Engl. J. Med. 290: 1403, 1974.

    Article  PubMed  CAS  Google Scholar 

  21. Yawata, Y., Hebbel, R.P., Silvis, S., Howe, R., and Jacob, H.: Blood cell abnormalities complicating the hypophosphatemia of hyperalimentation: Erythrocytes and platelet ATP deficiency associated with hemolytic anemia and bleeding in hyperalimented dog. J. Lab. Clin. Med. 84: 643, 1974.

    PubMed  CAS  Google Scholar 

  22. Stoerk, H.C., and Carnes, W.H.: The relation of the dietary Ca: P ratio to serum Ca and to parathyroid volume. J. Nutr. 29: 43, 1945.

    CAS  Google Scholar 

  23. Slatopolsky, E., Calger, S., Pennell, J.P., Taggart, D.D., Canterbury, J.M. Reiss, E., and Bricker, N.S.: On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J. Clin. Invest. 50: 492, 1971.

    Article  PubMed  CAS  Google Scholar 

  24. Dominguez, J.H., Fray, R.W., and Leman, J., Jr.: Dietary phosphate deprivation in women and men. Effects of mineral and acid balances, parathyroid hormone and the metabolism of 25-OH-vitamin D. J. Clin. Endocrinol. & Metab. 43: 1056, 1976.

    Article  CAS  Google Scholar 

  25. Tuller, M.A.: Myoglobinuria with or without drug usage. JAMA 217: 1868, 1971.

    Google Scholar 

  26. Knochel, J.P., Bilbrey, G.L., Fuller, T.J., and Carter, N.W.: The muscle cell in chronic alcoholism. The possible role of phosphate depletion in alcoholic myopathy. Ann. N.Y. Acad. Sci. 252: 274, 1975.

    Article  PubMed  CAS  Google Scholar 

  27. Fuller, T.J., Carter, N.W., Barcenas, C., and Knochel, J.P.: Reversible experimental myopathy associated with phosphorus depletion. J. Clin. Invest. 57: 1019, 1976

    Article  CAS  Google Scholar 

  28. O’Connor, L.R., Wheeler, W.S., and Bethune, J.E.: Effect of hypophosphatemia on myocardial performance in man. N. Engl. J. Med. 297: 901, 1977.

    Article  PubMed  Google Scholar 

  29. Fuller, R.J., Nichols, W.W., Brenner, B.J., and Peterson, J.C.: Effects of phosphorus depletion on left ventricular energy generation. In Homeostasis of Phosphate and Other Minerals, eds. Massry, S.G., Ritz, E., and Rapado, A., Plenum Publishing Co., New York, In Press, 1978.

    Google Scholar 

  30. Freeman, S., and McLean, F.C.: Experimental rickets. Blood and tissue changes in puppies receiving a diet very low in phos-horus, with and without vitamin D. Arch. Pathol. 32: 387, 1941.

    CAS  Google Scholar 

  31. Skikita, M., Tsurnfuji, S., and Ito, Y.: Adaptation in renal phosphorus excretion under the influence of parathyroids; a study of ureterally catheterized rats. Endocrinol. Jap. 9: 171, 1962.

    Article  Google Scholar 

  32. Kreusser, W.J., Kurokawa, K., Aznar, E., and Massry, S.G.: Phosphate depletion: Effect on renal inorganic phosphorus and adenine nucleotides, urinary phosphate and calcium, and calcium balance. Miner. Elect. Metab. 1: 30, 1978.

    CAS  Google Scholar 

  33. Cuisinier-Gleizes, P., Thomasset, M., Sainteny-DeLove, I., and Mathieu, H.: Phosphorus deficiency, parathyroid hormone, and bone resorption in the growing rat. Calcif. Tiss. Res. 20: 235, 1976.

    Article  CAS  Google Scholar 

  34. Kreusser, W.J., Kurokawa, K., Aznar, E., Sachtjen, E., and Massry, S.G.: Effect of phosphate depletion on magnesium homeostasis. J. Clin. Invest. 61: In press, 1978.

    Google Scholar 

  35. Barzel, U.S.: Parathyroid hormone, blood phosphorus, and acid-base metabolism. Lancet, 1: 1329, 1971.

    Article  PubMed  CAS  Google Scholar 

  36. Gold, L.W., Massry, S.G., Arieff, A.I., and Coburn, J.W.: Renal bicarbonate wasting during phosphate depletion: A possible cause of altered acid-base homeostasis in hyperparathyroidism. J. Clin. Invest. 52: 2556, 1973.

    Article  PubMed  CAS  Google Scholar 

  37. Massry, S.G., Kurokawa, K., Arieff, A.I., and Ben-Isaac, C.: Metabolic acidosis of hyperparathyroidism. Arch. Intern. Med. 134: 385, 1974.

    Article  PubMed  CAS  Google Scholar 

  38. Emmett, M., Goldfarb, S., Agus, Z.S., and Narins, R.C.: The pathophysiology of acid-base changes in chronically phosphate-depleted rats. Bone kidney interaction. J. Clin. Invest. 59: 291, 1977.

    Article  PubMed  CAS  Google Scholar 

  39. Coburn, J.W., and Massry, S.G.: Changes in serum and urinary calcium during phosphate depletion: Studies on mechanisms. J. Clin. Invest. 49: 1073, 1970.

    Article  PubMed  CAS  Google Scholar 

  40. Day, H.G., and McCollum, E.V.: Mineral metabolism, growth, and symptomatology of rats on a diet extremely deficient in phosphorus. J. Biol. Chem. 130: 269, 1939.

    CAS  Google Scholar 

  41. Young, V.R., Lofgreen, G.P., and Luick, J.R.: The effects of phosphorus depletion and of calcium and phosphorus intake on the endogenous excretion of these elements by sheep. Brit. J. Nutr. 20: 795, 1966.

    Article  PubMed  CAS  Google Scholar 

  42. Steele, T.H., Engle, J.E., Tanaka, Y., Lorenc, R.S., Dudgeson, K.L., and DeLuca, H.F.: On the phosphatemic action 1,25-dihydroxy vitamin D3. Amer. J. Physiol. 229: 489, 1975.

    CAS  Google Scholar 

  43. Steele, T.H., and DeLuca, H.F.: Influence of dietary phosphorus on renal phosphate reabsorption in the parathyroidectomized rats. J. Clin. Invest. 57: 867, 1976.

    Article  PubMed  CAS  Google Scholar 

  44. Trohler, V., Bonjour, J.P., and Fleish, J.: Inorganic phosphate homeostasis: Renal adaptation to the dietary intake in intact and thyroparathyroidectomized rats. J. Clin. Invest. 57: 264, 1976.

    Article  PubMed  CAS  Google Scholar 

  45. Beck, N.: Effect of dietary phosphorus (P) intake on renal actions of parathyroid hormone (PTH) and cyclic AMP (cAMP). Proc. Amer. Soc. Nephrol. 9: 1, 1976.

    Google Scholar 

  46. Goldfarb, S., Westby, G.R., Goldberg, M., and Agus, Z.S.: Renal tubular effects of chronic phosphate depletion. J. Clin. Invest. 59: 770, 1977.

    Article  PubMed  CAS  Google Scholar 

  47. Gold, L.W., Massry, S.G., and Friedler, R.M.: Effect of phosphate depletion on renal tubular reabsorption of glucose. J. Lab. Clin. Med. 89: 554, 1977.

    PubMed  CAS  Google Scholar 

  48. Kreusser, W.J., Descoeudres, C., Oda, Y., Aznar, E., and Massry, S.G.: Effects of phosphate depletion (PD) on renal gluconeogenesis (GNG). Proc. Amer. Soc. Nephrol. 10: 90A, 1977.

    Google Scholar 

  49. Tanaka, Y., and DeLuca, H.F.: The control of 25-hydroxyvitamin D metabolism by inorganic phosphorus. Arch. Biochem. Biophys. 154: 566, 1973.

    Article  PubMed  CAS  Google Scholar 

  50. Hughes, M.R., Haussier, M.R., Werdegal, J., and Baylink, D.J.: Regulation of serum la, dihydroxyvitamin D3 by calcium and phosphate in the rat. Science, 190: 578, 1975.

    Article  PubMed  CAS  Google Scholar 

  51. Ben-Isaac, C., Massry, S.G., Rosenfeld, S., Kleeman, C.R., and Bick, M.: Evidence for humoral factors responsible for the hypercalciuria of phosphate depletion. J. Clin. Invest. 53: 5a, 1974.

    Google Scholar 

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© 1978 Plenum Press, New York

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Massry, S.G. (1978). The Clinical Syndrome of Phosphate Depletion. In: Massry, S.G., Ritz, E., Rapado, A. (eds) Homeostasis of Phosphate and Other Minerals. Advances in Experimental Medicine and Biology, vol 103. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-7758-0_32

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  • DOI: https://doi.org/10.1007/978-1-4684-7758-0_32

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4684-7760-3

  • Online ISBN: 978-1-4684-7758-0

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