5th April 2024

Clinical manifestations

Many patients with mild (0.6 – 0.8 mmol/L) hypophosphatemia will report no specific symptoms. Common presentations include diaphragmatic, skeletal and cardiac muscle weakness, bone pain, altered mental status and rhabdomyolysis. Low phosphate states increase predisposition to haemolysis and thrombocytopenia. 

Severe and acute hypophosphatemia ( < 0.3 mmol/L) may present with focal neurological deficits, myalgia, congestive cardiac failure, seizures and altered mental status. 

If hypophosphatemia started from childhood, there may be short stature and bowed legs from rickets.

In an adult, marked hypophosphatemia with bone pain and excess urinary phosphate loss is suggestive of oncogenic osteomalacia.