Hypophosphatemia may be associated with a myopathy and/or acute rhabdomyolysis. A lack of phosphate may impair a cell's ability to form ATP. The diagnosis can be easily missed if serum phosphate is not measured or the results overlooked.
Severe hypophosphatemia may be associated with a myopathy featuring:
(1) muscle weakness
(2) elevated serum muscle enzymes
Hypophosphatemia may result in rhabdomyolysis when superimposed on a pre-existing myopathy, which may be subclinical. This is encountered in:
(1) chronic alcoholics
(2) diabetics, especially with ketoacidosis
(3) hypokalemia or hypomagnesemia
(4) other myopathies
The myopathy responds to:
(1) treatment of the underlying condition
(2) phosphate replacement
(3) vitamin D and calcium if there is hypophosphatemic osteomalacia
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