Hypophosphatemia in End Stage Renal Disease

Abstract

A case of hypophosphatemia in a 55-year-old black female on maintenance hemodialysis is described. She developed multiple bone fractures and congestive heart failure during her 10-year period on hemodialysis. Iliac crest bone biopsy revealed osteomalacia with absent aluminum stores. Management was difficult due to her noncompliance secondary to severe depression. Though osteomalacia and cardiomyopathy due to hypophosphatemia are described in patients with end stage renal disease on dialysis, it is an uncommon entity.

Euglycemic Diabetic Ketoacidosis Accompanied by Severe Hypophosphatemia During Recovery in a Patient With Type 2 Diabetes Being Treated With Canagliflozin/Metformin Combination Therapy

“… SGLT2 inhibitors can cause euglycemic DKA as a direct effect of their mechanisms of action, noninsulin-dependent glucose clearance, hyperglucagonemia, and volume depletion. The recovery phase of DKA may be associated with severe hypophosphatemia requiring timely and appropriate repletion of phosphate ( 9 , 10 ). Euglycemic DKA may be overlooked in the setting of moderately elevated blood glucose, which can lead to misdiagnosis, delayed treatment, and worsening metabolic derangements.…”

“…The recovery phase of DKA may be associated with severe hypophosphatemia requiring timely and appropriate repletion of phosphate ( 9 , 10 ).…”