Padelli Maël, Leven Cyril, Sakka Mehdi, Plée-Gautier Emmanuelle, Carré Jean-Luc
University hospital of Brest, department of biochemistry and pharmaco-toxicology, 29200 Brest, France.
University hospital of Brest, department of biochemistry and pharmaco-toxicology, 29200 Brest, France.
Presse Med. 2017 Nov;46(11):987-999. doi: 10.1016/j.lpm.2017.09.002. Epub 2017 Oct 28.
Although hypophosphatemia is usually very seldom, it can reach two to 3% of hospitalized patients and until 28% of intensive care unit patients. Due to the lack of knowledge, clinical practice regarding seeking or treatment of hypophosphatemia is very heterogenous. However its clinical consequences might be heavy. A better knowledge of its causes, physiopathological effects and treatment should lead to a documented and homogenous care of these patients in clinics.
The aim of our study was a systematic review of littérature, seeking for publications about causes, consequences and treatment of hypophosphatemia.
DOCUMENTARY SOURCES (KEYWORDS AND LANGUAGE): A research has been conducted on the Medline database by using the following keywords "phosphorus supplementation", "hypophosphatemia" and ("physiopathology" or "complications").
Three mains mechanisms might be responsible for hypophosphatemia: a decrease in digestive absorption, a rise in kidney excretion and a transfer of phosphorus to the intracellular compartment. Denutrition, acid base balance troubles, parenteral nutrition or several drugs are capable of provoking or favouring hypophosphatemia. All these situations are frequently encountered in intensive care unit. Consequences of hypophosphatemia might be serious. Best studied and documented are cardiac and respiratory muscle contractility decrease, sometimes leading to acute cardiac and respiratory failure, cardiac rhythm troubles and cardiac arrest. Hypophosphatemia is frequent during sepsis. It could be responsible for leucocyte dysfunction that might favour or increase sepsis. The treatment of hypophosphatemia is usually simple through a supplementation that quickly restores a regular concentration, with few adverse effects when regularly used.
During at-risk situations, the systematic search for hypophosphatemia and its treatment may limit the occurrence of serious consequences.
尽管低磷血症通常很少见，但在住院患者中其发生率可达2%至3%，在重症监护病房患者中可达28%。由于认识不足，在低磷血症的筛查或治疗方面，临床实践差异很大。然而，其临床后果可能很严重。更好地了解其病因、生理病理影响和治疗方法，应能使临床对这些患者的治疗有据可依且保持一致。
我们研究的目的是对文献进行系统综述，查找有关低磷血症的病因、后果和治疗的出版物。
文献来源（关键词和语言）：通过在Medline数据库中使用以下关键词进行了一项研究：“磷补充”、“低磷血症”以及（“生理病理学”或“并发症”）。
低磷血症可能由三种主要机制引起：消化吸收减少、肾脏排泄增加以及磷向细胞内转移。营养不良、酸碱平衡紊乱、肠外营养或多种药物都可能引发或加重低磷血症。所有这些情况在重症监护病房中都很常见。低磷血症的后果可能很严重。研究和记录最多的是心肌和呼吸肌收缩力下降，有时会导致急性心功能和呼吸功能衰竭、心律失常和心脏骤停。脓毒症期间低磷血症很常见。它可能导致白细胞功能障碍，进而加重或促进脓毒症。低磷血症的治疗通常很简单，通过补充磷可迅速恢复正常浓度，定期使用时副作用很少。
在存在风险的情况下，系统筛查低磷血症并进行治疗可能会减少严重后果的发生。
