Several factors may contribute to hypophosphatemia in critically ill patients. The most common factors in these patients include infusions of glucose and insulin as well as the refeeding syndrome (T§.ble 2.). Insulin production stimulated by glucose infusions or high caloric intake after a period of inadequate feeding results in transcellular shifts in phosphate from the extracellular to the intracellular space.

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Table 2 Common causes of severe hypophosphatemia

The condition can also be ascribed to inadequate input, transcellular shifts, or excessive losses ( Tab!e...3). If the cause is not clear, a spot urinary phosphate level is helpful. If the concentration is less than 1.2 mmol/l (40 mg/l) despite significant hypophosphatemia, excessive renal losses can be excluded. If the urinary level is elevated, excessive renal losses, such as diuretic drug administration or the diuretic phase of acute renal failure, are the most likely cause ( Bourke and Yanagawa

Table 3 A systematic etiology of hypophosphatemia

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