Phosphate is an essential electrolyte for proper mineralisation of bone,buffering of urine,and diverse cellular actions.Hypophosphatemia(HP)is a clinical spectrum which range from asymptomatic to severe complications ...Phosphate is an essential electrolyte for proper mineralisation of bone,buffering of urine,and diverse cellular actions.Hypophosphatemia(HP)is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications,or even death.Post-hepatectomy HP(PHH)has been reported to be 55.5%-100%.Post-hepatectomy,there is rapid uptake of phosphate and increased mitotic counts to aid in regeneration of residual liver.Concurrently,PHH may be due to increased urinary phosphorous from activation of matrix extracellular phosphoglycoprotein in the injured liver,which decreases phosphate influx into hepatocytes to sustain adenosine triphosphate synthesis.A literature review was performed on Pub Med till January 2022.We included 8 studies which reported on impact of PHH on post-operative outcomes.In patients with diseased liver,PHH was reported to have either beneficial or deleterious effects on post-hepatectomy liver failure(PHLF),morbidity and/or mortality in various cohorts.In living donor hepatectomy,PHLF was higher in PHH.Benefits of correction of PHH with reduced postoperative complications have been shown.Correction of PHH should be done based on extent of PHH.Existing studies were however heterogenous;further studies should be conducted to assess PHH on post-operative outcomes with standardized phosphate replacement regimes.展开更多
To examine whether lanthanum carbonate can induce a low phosphorus status in experimental animals, we examined phosphorus balance in rats administered lanthanum carbonate. Male 8-week-old Wistar rats were fed a basal ...To examine whether lanthanum carbonate can induce a low phosphorus status in experimental animals, we examined phosphorus balance in rats administered lanthanum carbonate. Male 8-week-old Wistar rats were fed a basal case-in-based semi-purified diet or the basal diet supplemented with 0.45% or 0.90% lanthanum as lanthanum carbonate for 4 weeks. Lanthanum administration did not influence body or several organ weights and liver function. In rats administered lanthanum, a very small quantity of lanthanum was detected in several organs although the apparent absorption was almost zero. The highest lanthanum concentration was observed in the liver followed by the femur and kidney. Lanthanum was not clearly detected in the brain. Differences in organ lanthanum between 0.45% and 0.90% administration groups were not significant;lanthanum accumulation in the body is very low and may reach a plateau in a certain range of intake. Serum phosphorus was decreased and fecal phosphorus was increased by lanthanum administration dose-dependently. Urinary phosphorus excretion was significantly decreased by lanthanum. Since urinary phosphorus of rats fed 0.45% lanthanum diet decreased to near zero, the highest phosphorus balance was observed in rats fed 0.45% lanthanum diet. This high balance is considered to be adaptation to the low phosphorus status induced by lanthanum carbonate. These results indicate that lanthanum carbonate can induce hypophosphatemia without any direct side effects and be used to examine the effect of removing phosphorus from the diet in animal nutritional studies.展开更多
Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstruc...Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstructive pulmonary disease, admitted with acute respiratory failure and low serum phosphate level, her clinical signs and serum phosphate level did not improve with conventional therapy and intravenous phosphate replacement, until her recently commenced uniphyline was discontinued. This highlights the importance of awareness amongst the clinicians about this rare but potential side effect of uniphyline. We suggest monitoring phosphate levels in patients admitted with acute respiratory failure especially those on extended bronchodilator therapy.展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF)is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection.Some studies suggest that the postoperative ser...BACKGROUND Post-hepatectomy liver failure(PHLF)is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection.Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.AIM To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.METHODS This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement.A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database.PubMed,Cochrane and Lippincott Williams&Wilkins databases were systematically searched up to March 31,2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF,overall postoperative morbidity and liver regeneration.The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.RESULTS After final assessment,nine studies(eight retrospective and one prospective cohort study)with 1677 patients were included in the systematic review.All selected studies scored≥6 points according to the Newcastle-Ottawa Scale.Cutoff values of hypophosphatemia varied from<1 mg/dL to≤2.5 mg/dL in selected studies with≤2.5 mg/dL being the most used defining value.Five studies analyzed PHLF,while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia.Only two of the selected studies analyzed postoperative liver regeneration,with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia.In three studies hypophosphatemia was associated with better postoperative outcomes,while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.CONCLUSION Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection.However,routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.展开更多
Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as ...Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as a result of the drug＇s relatively slow equilibration across cellular membranes. Use of a conventional, phosphorus-free, bicarbonate-based dialysis solution in the course of a dialytic treatment may engender hypophosphatemia in these individuals.展开更多
目的:探讨低磷血症对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的影响。方法:回顾性分析2013年1月至2022年12月安徽医科大学第二附属医院重症医学科(intensive care unit,ICU)收治符合入组标准的179例SAP患者的临床资料...目的:探讨低磷血症对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的影响。方法:回顾性分析2013年1月至2022年12月安徽医科大学第二附属医院重症医学科(intensive care unit,ICU)收治符合入组标准的179例SAP患者的临床资料。根据患者入院时测定的血磷水平分为低磷血症组(血磷<0.80 mmol/L)和非低磷血症组(血磷≥0.80 mmol/L)。记录患者入院时的一般情况、ICU住院时间、总住院时间、机械通气情况、临床预后和并发症等临床资料。采用多因素logistic回归分析评估低磷血症与SAP患者继发腹腔感染和预后的关系。绘制受试者工作特征(receiver operator characteristic,ROC)曲线,计算ROC曲线下面积(area under the curve,AUC)及其95%可信区间(95%confidence interval,95%CI),评价多元回归模型对SAP患者继发腹腔感染和院内死亡的预测价值。结果:与非低磷血症组相比,低磷血症组需要机械通气的比例、腹腔感染的发生率明显升高,总住院时间明显延长[机械通气比例:60.3%(47/78)比44.6%(45/101),腹腔感染的发生率:43.6%(34/78)比22.8%(23/101),总住院时间(d):26.5(16.0,34.5)比20.0(14.0,30.0),均P<0.05]。2组患者在腹腔出血、机械通气时间、ICU住院时间和住院期间死亡率方面比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一,OR值分别为2.985(95%CI=1.434~6.213,P<0.05)和2.878(95%CI=1.069~7.747,P<0.05)。ROC曲线分析显示,多元回归模型预测SAP患者继发腹腔感染和院内死亡的AUC分别为0.797(95%CI=0.729~0.886)和0.879(95%CI=0.816~0.942),均P<0.001。结论:低磷血症的SAP患者机械通气和继发腹腔感染的比例更高,总住院时间更长。低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一。展开更多
文摘Phosphate is an essential electrolyte for proper mineralisation of bone,buffering of urine,and diverse cellular actions.Hypophosphatemia(HP)is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications,or even death.Post-hepatectomy HP(PHH)has been reported to be 55.5%-100%.Post-hepatectomy,there is rapid uptake of phosphate and increased mitotic counts to aid in regeneration of residual liver.Concurrently,PHH may be due to increased urinary phosphorous from activation of matrix extracellular phosphoglycoprotein in the injured liver,which decreases phosphate influx into hepatocytes to sustain adenosine triphosphate synthesis.A literature review was performed on Pub Med till January 2022.We included 8 studies which reported on impact of PHH on post-operative outcomes.In patients with diseased liver,PHH was reported to have either beneficial or deleterious effects on post-hepatectomy liver failure(PHLF),morbidity and/or mortality in various cohorts.In living donor hepatectomy,PHLF was higher in PHH.Benefits of correction of PHH with reduced postoperative complications have been shown.Correction of PHH should be done based on extent of PHH.Existing studies were however heterogenous;further studies should be conducted to assess PHH on post-operative outcomes with standardized phosphate replacement regimes.
文摘To examine whether lanthanum carbonate can induce a low phosphorus status in experimental animals, we examined phosphorus balance in rats administered lanthanum carbonate. Male 8-week-old Wistar rats were fed a basal case-in-based semi-purified diet or the basal diet supplemented with 0.45% or 0.90% lanthanum as lanthanum carbonate for 4 weeks. Lanthanum administration did not influence body or several organ weights and liver function. In rats administered lanthanum, a very small quantity of lanthanum was detected in several organs although the apparent absorption was almost zero. The highest lanthanum concentration was observed in the liver followed by the femur and kidney. Lanthanum was not clearly detected in the brain. Differences in organ lanthanum between 0.45% and 0.90% administration groups were not significant;lanthanum accumulation in the body is very low and may reach a plateau in a certain range of intake. Serum phosphorus was decreased and fecal phosphorus was increased by lanthanum administration dose-dependently. Urinary phosphorus excretion was significantly decreased by lanthanum. Since urinary phosphorus of rats fed 0.45% lanthanum diet decreased to near zero, the highest phosphorus balance was observed in rats fed 0.45% lanthanum diet. This high balance is considered to be adaptation to the low phosphorus status induced by lanthanum carbonate. These results indicate that lanthanum carbonate can induce hypophosphatemia without any direct side effects and be used to examine the effect of removing phosphorus from the diet in animal nutritional studies.
文摘Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstructive pulmonary disease, admitted with acute respiratory failure and low serum phosphate level, her clinical signs and serum phosphate level did not improve with conventional therapy and intravenous phosphate replacement, until her recently commenced uniphyline was discontinued. This highlights the importance of awareness amongst the clinicians about this rare but potential side effect of uniphyline. We suggest monitoring phosphate levels in patients admitted with acute respiratory failure especially those on extended bronchodilator therapy.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF)is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection.Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.AIM To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.METHODS This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement.A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database.PubMed,Cochrane and Lippincott Williams&Wilkins databases were systematically searched up to March 31,2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF,overall postoperative morbidity and liver regeneration.The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.RESULTS After final assessment,nine studies(eight retrospective and one prospective cohort study)with 1677 patients were included in the systematic review.All selected studies scored≥6 points according to the Newcastle-Ottawa Scale.Cutoff values of hypophosphatemia varied from<1 mg/dL to≤2.5 mg/dL in selected studies with≤2.5 mg/dL being the most used defining value.Five studies analyzed PHLF,while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia.Only two of the selected studies analyzed postoperative liver regeneration,with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia.In three studies hypophosphatemia was associated with better postoperative outcomes,while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.CONCLUSION Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection.However,routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.
文摘Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as a result of the drug＇s relatively slow equilibration across cellular membranes. Use of a conventional, phosphorus-free, bicarbonate-based dialysis solution in the course of a dialytic treatment may engender hypophosphatemia in these individuals.
文摘目的:探讨低磷血症对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的影响。方法:回顾性分析2013年1月至2022年12月安徽医科大学第二附属医院重症医学科(intensive care unit,ICU)收治符合入组标准的179例SAP患者的临床资料。根据患者入院时测定的血磷水平分为低磷血症组(血磷<0.80 mmol/L)和非低磷血症组(血磷≥0.80 mmol/L)。记录患者入院时的一般情况、ICU住院时间、总住院时间、机械通气情况、临床预后和并发症等临床资料。采用多因素logistic回归分析评估低磷血症与SAP患者继发腹腔感染和预后的关系。绘制受试者工作特征(receiver operator characteristic,ROC)曲线,计算ROC曲线下面积(area under the curve,AUC)及其95%可信区间(95%confidence interval,95%CI),评价多元回归模型对SAP患者继发腹腔感染和院内死亡的预测价值。结果:与非低磷血症组相比,低磷血症组需要机械通气的比例、腹腔感染的发生率明显升高,总住院时间明显延长[机械通气比例:60.3%(47/78)比44.6%(45/101),腹腔感染的发生率:43.6%(34/78)比22.8%(23/101),总住院时间(d):26.5(16.0,34.5)比20.0(14.0,30.0),均P<0.05]。2组患者在腹腔出血、机械通气时间、ICU住院时间和住院期间死亡率方面比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一,OR值分别为2.985(95%CI=1.434~6.213,P<0.05)和2.878(95%CI=1.069~7.747,P<0.05)。ROC曲线分析显示,多元回归模型预测SAP患者继发腹腔感染和院内死亡的AUC分别为0.797(95%CI=0.729~0.886)和0.879(95%CI=0.816~0.942),均P<0.001。结论:低磷血症的SAP患者机械通气和继发腹腔感染的比例更高,总住院时间更长。低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一。
