Hyperphosphatemia refers to excessive 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 cardiovascular disease in the long term.
What is hyperphosphatemia?
Hyperphosphatemia represents an elevated phosphate concentration in the blood. The increase in phosphate concentration can occur very rapidly or over a long period of time. Its rapid increase is called acute hyperphosphatemia. At the same time, there is a sharp decrease in calcium concentration (hypocalcemia), which leads to massive disturbance of 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 developing heart attacks and strokes. Phosphate, calcium and bone metabolism are closely linked. Bones are made up of more than 80 percent calcium phosphate. In chronic hyperphosphatemia, bone loss occurs in the long term in addition to vascular calcification. The kidney is the most important organ for regulating phosphate concentration. It ensures the excretion of excess phosphates through the urine.
Causes
In terms of both cause and effect, acute and chronic hyperphosphatemias must be considered separately. In acute hyperphosphatemia, phosphate intake is so massive that the capacity of the kidney is far exceeded. However, renal function is normal in this case. Phosphate intake, in turn, can be both exogenous and endogenous. Phosphate-containing solutions used for bowel cleansing, for example, can lead to acute hyperphosphatemia, especially in the elderly. Of course, this also applies to drinking phosphate solutions. However, endogenous causes also sometimes cause acute hyperphosphatemia. For example, the sudden necrosis of endogenous tissue or hemolysis releases the phosphates from the dead cells. When renal capacity is exceeded, acute hyperphosphatemia occurs. Chronic hyperphosphatemia almost always results from a lack of renal capacity. The resorption capacity of the kidneys for phosphates is reduced. As a result, their concentration in the blood slowly increases. However, these processes are very complex. Increased phosphate concentration binds calcium forming calcium phosphate. The lowered calcium concentrations cause increased bone resorption via a feedback mechanism. The calcium phosphates are deposited as calcium-like salts in the blood vessels and in the long term lead to arteriosclerosis, heart attacks or strokes. However, there are also hormonal or genetic conditions that can lead to hyperphosphatemia due to increased reabsorption of phosphate from the primary urine despite normal renal function. These include hypoparathyroidism, acromegaly, or familial tumorous calcinosis. Intravenous nutrition, bisphosphonate treatment, or vitamin D intoxication can also lead to hyperphosphatemia. Furthermore, chemotherapy, acute leukemia, or diabetic ketoacidosis produce increased phosphates.
Symptoms, complaints, and signs
Acute hyperphosphatemia is a very life-threatening condition. The greatly increased phosphate concentrations simultaneously cause a sharp drop in blood calcium concentrations. Calcium ions and phosphate ions immediately form poorly soluble salts of calcium phosphate. The resulting hypocalcemia upsets the electrolyte balance of the body. Such symptoms as nausea, vomiting, diarrhea, seizures, muscle cramps, circulatory problems or cardiac arrhythmias occur. As a result, sudden cardiac death may occur. Chronic hyperphosphatemia does not initially cause any 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 clogged and stiff. Over time, this can lead to heart attacks and strokes. A rare but very painful and severe form of chronic hyperphosphatemia is known as calciphylaxis.In this case, severe media calcification of the skin vessels leads to the death of skin tissue. The tissue turns dark blue to black, mummifies, and may also fall off.
Diagnosis and course of the disease
Laboratory tests for phosphates and calcium are performed to clarify hyperphosphatemia.
Complications
Hyperphosphatemia causes a variety of complaints in patients. In most cases, this results in relatively severe stress and discomfort to the heart, so cardiovascular problems may develop. As a result, the patient’s life expectancy is reduced and death may occur due to sudden cardiac death. In general, the patient feels sick and tired and suffers from severe fatigue. Social contacts also become limited and most patients withdraw due to hyperphosphatemia and no longer actively participate in life. Cramps may occur in the muscles, so that movement is also restricted. 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 daily life. Due to the diarrhea and vomiting, a high loss of fluid occurs. If this loss is not compensated, dehydration can occur, which is very unhealthy for the body. Treatment usually takes place with the help of infusions and medications and can acutely relieve the symptoms. No further complications or special complaints occur.
When should you go to the doctor?
If symptoms such as nausea and vomiting, diarrhea, and seizures are noticed, hyperphosphatemia may be underlying. A doctor should be consulted if symptoms persist longer than usual. The condition represents a life-threatening condition that requires emergency medical treatment in any case. For this reason, 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 administered. Subsequently, a longer stay in hospital is usually indicated. People who suffer from vitamin D poisoning, acute leukemia, diabetic ketoacidosis or acromegaly are particularly at risk. There is also a risk of hyperphosphatemia in connection with intravenous nutrition or biphisphonate treatment. Anyone who is in one of these risk groups should seek immediate hospitalization if they experience any of the symptoms mentioned above. In case of doubt, the attending physician 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 hospital is indicated.
Treatment and therapy
Treatment of hyperphosphatemia is initially based on whether it is acute or chronic. In acute hyperphosphatemia, immediate action is needed. In this case, phosphate excretion is accelerated by an infusion of physiologic saline. Dialysis treatment may also be given. In chronic hyperphosphatemia, in addition to treatment of the underlying disease, phosphate uptake and phosphate release must be inhibited or phosphate binding promoted by various measures. Chronic hyperphosphatemia occurs at a late stage in renal disease, so that causal treatment is no longer possible here. Therefore, measures are taken to keep the phosphate concentration as low as possible by other treatment methods. A low-phosphate diet and various phosphate binders reduce the absorption of phosphate from food. Vitamin D intake can inhibit increased bone resorption and thus phosphate release. In this context, it has been shown that treatment with phosphate binders and vitamin D can significantly increase life expectancy in dialysis patients.
Outlook and prognosis
The outlook for improved health in hyperphosphatemia depends on the underlying disease present as well as the intensity of the symptoms. In an acute situation, the affected person’s life is in danger without immediate intensive medical treatment. Dialysis treatment is necessary to bring about relief from the symptoms.If the treatment is accepted by the organism, the condition of the affected person improves at least temporarily. The next steps involve clarifying the causes and drawing up a treatment plan. In the case of a chronic underlying disease, the prognosis is usually unfavorable. Since hyperphosphatemia remains asymptomatic for a long time, this makes diagnosis and treatment difficult. Nevertheless, calcium deposits in the organism increase continuously and ultimately lead to an acute health condition. In addition to endangering life, it can lead to lifelong impairments and disorders. The disease causes a degradation of the bone substance and thus leads to a decrease in physical performance. The damage is irreparable; only the progress 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 secondary symptoms and further illnesses. If the diagnosis is made early, causal treatment can be initiated in some patients. Phosphate balance is regulated and monitored. Here, there is a prospect for permanent relief or cure.
Prevention
Hyperphosphatemia is always a secondary condition of an underlying disease or disorder. In the case of chronically high phosphate concentration, renal insufficiency usually underlies the condition. Renal disorders can have many causes. However, they are often the result of a poor lifestyle. Renal insufficiency often occurs together with diabetes mellitus, cardiovascular disorders, lipid metabolism disorders and obesity. Therefore, prevention from these diseases through a healthy lifestyle, plenty of exercise, and abstaining from alcohol and smoking is important.
Follow-up
In many cases of hyperphosphatemia, the affected person has very few or no direct options for aftercare. The affected person is primarily dependent on a quick diagnosis, as hyperphosphatemia can lead to the patient’s death in the worst case. The earlier the disease is detected, the better the further course of the disease usually is. A doctor should be consulted at the very first symptoms and signs of the disease. In most cases, the symptoms can be relatively well alleviated by drinking a saline solution. However, dialysis is often necessary. Those affected are dependent on the help and support of their own family, which can make life much easier. Furthermore, it may also be necessary to take medication. Patients should ensure that they take their medication regularly and in the correct dosage to alleviate their symptoms. The intake of phosphate through food should also be regulated. Despite treatment, hyperphosphatemia usually results in a significantly reduced life expectancy of the patient.
What you can do yourself
If the hyperphosphatemia is acute and severe, there are usually no self-help options available to the affected person. In this case, immediate medical assistance is necessary to prevent the death of the affected person. In this case, treatment is carried out by an emergency physician 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 performed to support the body. If hyperphosphatemia is a chronic disease, the affected person should take care not to take in too much phosphate through his diet. Here, a diet plan or a discussion with a nutritionist can be very helpful. Taking vitamin D also has a very positive effect on the course of hyperphosphatemia and can alleviate bone loss. Furthermore, phosphate binders must also be taken regularly, although consultation with a physician should be the first step. In general, contact with other sufferers 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.
