UMEM Educational Pearls

Category: Critical Care

Title: Drug-Induced Hypophosphatemia

Posted: 8/10/2010 by Mike Winters, MD (Updated: 5/29/2023)
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Drug-Induced Hypophosphatemia

  • 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


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.