Hyperphosphatemia refers to an excessively high phosphate concentration in the blood. There are acute and chronic forms of this disorder. Acute hyperphosphatemia is a medical emergency and life-threatening, while chronic phosphate overload leads to long-term cardiovascular disease.
What is hyperphosphatemia?
Laboratory tests for phosphates and calcium are carried out to clarify hyperphosphatemia. See AbbreviationFinder for abbreviations related to Hyperphosphatemia.
Hyperphosphatemia represents an increased phosphate concentration in the blood. The increase in phosphate concentration can occur very quickly or over a longer period of time. Their rapid increase is called acute hyperphosphatemia. At the same time, there is a sharp decrease in the calcium concentration (hypocalcaemia), which leads to massive disruption of the electrolyte balance. This condition is extremely life-threatening.
Chronic hyperphosphatemia is usually the result of renal dysfunction and initially causes no symptoms. In the long term, this form of hyperphosphatemia causes calcium deposits to form in the blood vessels, with the risk of heart attacks and strokes. Phosphate, calcium and bone metabolism are closely linked.
Bones are made up of more than 80 percent calcium phosphate. In the case of chronic hyperphosphatemia, in addition to the calcification of the blood vessels, there is also a long-term deterioration of the bones. The kidney is the most important organ for regulating the phosphate concentration. It ensures that excess phosphates are excreted in the urine.
Both with regard to cause and effect, acute and chronic hyperphosphatemia must be considered separately. In acute hyperphosphatemia, the phosphate intake is so massive that the capacity of the kidneys is far exceeded. However, the kidney function is normal. The phosphate supply can in turn be either exogenous or endogenous.
For example, solutions containing phosphate, which are used for cleaning the intestines, for example, can lead to acute hyperphosphatemia, especially in older people. Of course, this also applies to drinking phosphate solutions. However, endogenous causes sometimes also cause acute hyperphosphatemia. In the event of sudden necrosis of endogenous tissue or hemolysis, the phosphates of the dead cells are released.
When renal capacity is exceeded, acute hyperphosphatemia occurs. Chronic hyperphosphatemia is almost always caused by poor kidney function. The ability of the kidneys to absorb phosphates is reduced. As a result, their concentration in the blood slowly increases. However, these processes are very complex. An increased phosphate concentration binds calcium to form calcium phosphate.
The lowered calcium concentrations allow bones to be broken down to an increased extent via a feedback mechanism. The calcium phosphates are deposited as lime-like salts in the blood vessels and lead to arteriosclerosis, heart attacks or strokes in the long term. However, there are also hormonal or genetic diseases which, despite normal kidney function, can lead to hyperphosphatemia due to increased reabsorption of phosphate from the primary urine.
These include hypoparathyroidism, acromegaly or familial tumorous calcinosis. Intravenous nutrition, bisphosphonate treatment or vitamin D poisoning can also lead to hyperphosphatemia. In addition, phosphates accumulate during chemotherapy, acute leukemia or diabetic ketoacidosis.
Symptoms, Ailments & Signs
Acute hyperphosphatemia is a very life-threatening condition. At the same time, the greatly increased phosphate concentrations lead to a sharp drop in the calcium concentration in the blood. Calcium ions and phosphate ions immediately form poorly soluble salts from calcium phosphate. The resulting hypocalcaemia upsets the body’s electrolyte balance.
Symptoms such as nausea, vomiting, diarrhea, seizures, muscle spasms, circulatory problems or cardiac arrhythmias appear. As a result, sudden cardiac death can occur. Chronic hyperphosphatemia initially causes no symptoms. In the long term, however, more and more deposits of calcium phosphate form in the arteries, joints or organs.
The blood vessels can become blocked and stiffen. Over time, heart attacks and strokes can occur. A rare but very painful and severe form of chronic hyperphosphatemia is what is known as calciphylaxis. This leads to the death of skin tissue due to severe media calcification of the skin vessels. The tissue turns dark blue to black, mummifies and may also fall off.
Diagnosis & course of disease
Laboratory tests for phosphates and calcium are carried out to clarify hyperphosphatemia.
Hyperphosphatemia causes different symptoms in patients. In most cases, this leads to relatively heavy stress and heart problems, so that cardiovascular problems can also develop. This reduces the life expectancy of the patient and the affected person can die from sudden cardiac death.
In general, the patient feels ill and tired and suffers from severe exhaustion. Social contacts are also restricted and most patients withdraw due to hyperphosphatemia and no longer actively participate in life. The muscles can cramp, which also restricts movement. Furthermore, most patients suffer from vomiting and nausea.
It is not uncommon for severe diarrhea to occur, which also has a negative effect on the patient’s everyday life. Diarrhea and vomiting result in a high loss of fluid. If this loss is not compensated, dehydration can occur, which is very unhealthy for the body. The treatment usually takes place with the help of infusions and medication and can relieve the symptoms acutely. There are no further complications or special complaints.
When should you go to the doctor?
If symptoms such as nausea and vomiting, diarrhea, and seizures are noticed, hyperphosphatemia may be the underlying cause. A doctor should be consulted if symptoms persist longer than usual. The disease is a life-threatening condition that always requires emergency medical treatment. That is why the emergency services should be alerted at the latest when there are clear warning signs such as circulatory problems or muscle cramps. If the victim loses consciousness, first aid must be given. A longer hospital stay is then usually indicated.
People suffering from vitamin D poisoning, acute leukemia, diabetic ketoacidosis or acromegaly are particularly at risk. There is also a risk of hyperphosphatemia associated with intravenous nutrition or biphosphonate treatment. Anyone who counts themselves among these risk groups should go to a hospital immediately if they experience the symptoms mentioned. In case of doubt, the doctor treating you can be contacted first. The disease requires clarification and treatment by a specialist in internal medicine. In severe cases, intensive medical care in a specialist clinic is indicated.
Treatment & Therapy
The treatment of hyperphosphatemia initially depends on whether it is acute or chronic. In the case of acute hyperphosphatemia, immediate action is required. Here the phosphate excretion is accelerated by an infusion of physiological saline solution. Dialysis treatment can also be performed.
In the case of chronic hyperphosphatemia, in addition to treating the underlying disease, various measures must be taken to inhibit phosphate uptake and phosphate release or to promote phosphate binding. Chronic hyperphosphatemia occurs in kidney diseases at a late stage, so that causal treatment is no longer possible.
Measures are therefore taken to keep the phosphate concentration as low as possible using other treatment methods. A low-phosphate diet and various phosphate binders reduce the absorption of phosphate from food. By taking vitamin D, the increased bone loss and thus the release of phosphate can be inhibited. It has been shown that treatment with phosphate binders and vitamin D can significantly increase the life expectancy of dialysis patients.
Outlook & Forecast
In the case of hyperphosphatemia, the prospect of an improvement in health depends on the underlying disease and the intensity of the symptoms. In an acute situation, without immediate intensive medical treatment, there is a risk of death for the person concerned. Dialysis treatment is necessary to alleviate the symptoms. If the organism accepts the treatment, the condition of the affected person improves, at least temporarily. In the next steps, it is necessary to clarify the cause and to draw up a treatment plan.
In the case of a chronic underlying disease, the prognosis is usually unfavorable. Since hyperphosphatemia remains symptom-free for a long time, this makes diagnosis and treatment difficult. Nevertheless, calcium deposits in the organism continue to increase and ultimately lead to an acute health condition. In addition to the danger to life, there can be lifelong impairments and disorders. The disease causes a breakdown of the bone substance and thus leads to a decrease in physical performance. The damage is irreparable, only the progression of the disease can be influenced. The overall quality of life is reduced and a restructuring of everyday life is necessary. The general condition of the patient can lead to sequelae and other diseases.
With early diagnosis, causal treatment can be initiated in some patients. The phosphate balance is regulated and monitored. Here there is a prospect of permanent relief or healing.
Hyperphosphatemia is always a sequela of an underlying disease or disorder. The chronically high phosphate concentration is usually due to renal insufficiency. Kidney disease can have many causes. However, they are often the result of a wrong way of life. Renal insufficiency often occurs together with diabetes mellitus, cardiovascular disorders, dyslipidemia and obesity. It is therefore important to prevent these diseases through a healthy lifestyle, lots of exercise and not drinking alcohol or smoking.
In the case of hyperphosphatemia, in many cases the affected person has very few or no direct options for aftercare. The person concerned is primarily dependent on a quick diagnosis, since the hyperphosphatemia can, in the worst case, lead to the death of the patient. The earlier the disease is detected, the better the further course of the disease.
A doctor should be consulted as soon as the first symptoms and signs of the disease appear. In most cases, drinking a saline solution can relieve the symptoms relatively well. However, dialysis is often necessary. Those affected depend on the help and support of their own families, which can make life much easier.
It may also be necessary to take medication. Those affected should ensure that they take it regularly with the right dosage in order to relieve the symptoms. The intake of phosphate from food should also be regulated. Despite treatment, hyperphosphatemia usually leads to a significantly reduced life expectancy for the patient.
You can do that yourself
If the hyperphosphatemia is acute and severe, the affected person usually has no options for self-help. In this case, immediate medical assistance is necessary to avoid the death of the person concerned. The treatment is carried out by an emergency doctor or in a hospital by giving a saline solution as an infusion. The supply of phosphate must be interrupted in any case. In emergencies, dialysis can also be done to support the body.
If hyperphosphatemia is a chronic disease, the person affected should be careful not to consume too much phosphate through their diet. A diet plan or a conversation with a nutritionist can be very helpful. Taking vitamin D also has a very positive effect on the course of hyperphosphatemia and can alleviate the breakdown of bones.
Furthermore, phosphate binders must also be taken regularly, although a consultation with a doctor should take place first and foremost. In general, contact with other affected people can also have a positive effect on the disease. This leads to an exchange of information, which can above all contribute to a correct diet.