Hypophosphatemia is seen in almost 30% of critically ill patients.
As discussed in a prior pearl, hypophosphatemia can result in respiratory failure along with cardiac and neurologic abnormalities.
Although common ED causes of hypophosphatemia include sepsis, hypothermia, and dialysis, don't forget about medications.
Medications that can cause significant hypophosphatemia in the critically ill (along with their mechanism) include:
Decreased GI intake: antacids, sucralfate
Transcellular shift: aspirin overdose, albuterol, catecholamines, insulin, and bicarbonate
Increased urinary excretion: diuretics, acetaminophen overdose, and theophylline overdose
References
Buckley MS, LeBlanc JM, Cawley MJ. Electrolyte disturbances associated with commonly prescribed medications in the intensive care unit. Crit Care Med 2010; 38(S):S253-S264.
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