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A logical approach to hyperphosphatemia is to divide the etiologies into increased load, decreased renal excretion, or transcellular shifts from the intracellular to the extracellular space (Table 1). The most common cause of hyperphosphatemia in the critically ill patient is endstage renal failure, and hyperphosphatemia is rare in the presence of a normal or only moderately impaired renal function. Other causes pertinent to the critically ill patient include transcellular shifts caused by acidosis, rhabdomyolysis, and malignant hyperpyrexia, as well as exogenous phosphate from laxatives and enemas.

Table 1 Systematic etiology of hyperphosphatemia

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