Hypophosphatemia is a serum phosphate concentration < 2.5 mg/dL (0.81 mmol/L). Mild hypophosphatemia is somewhat common and usually isn’t a cause for concern however severe hypophosphatemia can be life-threatening and requires medical treatment. The UK Medicines Information group have provided excellent guidance on how to replace phosphate.

Clinical features

  • Generally asymptomatic if mild
  • Can cause many systemic features
    • CNS & MSK: weakness/myalgia, lethargy, confusion, seizures
    • Cardiorespiratory failure
    • Rickets/Osteomalacia if chronic


  • Malabsorption
  • D&V
  • Refeeding syndrome
  • Chronic alcohol use


  • Check the calcium, U&Es, renal function


  • Use local guidelines or consider the information above
  • Typically oral replacement for a mild deficiency (e.g. phosphate Sandoz) & IV therapies if moderate or severe
    • PO therapy risks diarrhoea
    • IV therapy via phosphate polyfusor has a large amount of potassium. Be careful of this contraindication in patients with hyperkalaemia

References & further reading

  • Katzel, J.A., Vucuscu, R., Garcia, R., 2013. Wards 101 pocket clinician’s survival guide. Börm Bruckmeier Publishing.
  • Lewis III, J. L., 2018. Hypophosphatemia. MSD Manual Professional Version.
  • Mozingo, D.W. and Mason Jr, A.D., 2018. Hypophosphatemia. In Total Burn Care (pp. 280-286). Elsevier.

By Dr Shoaib Hussain
Edited by Pratyush Pradeep

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