Hypophosphatemia in critical care in adult patients (literature review)
https://doi.org/10.24884/2078-5658-2026-23-1-118-127
Abstract
Hypophosphatemia is a common metabolic disorder in intensive care unit (ICU) patients. A deficiency in serum phosphate can develop primarily due to three reasons: reduced intestinal phosphate absorption, redistribution of phosphate from the extracellular to the intracellular compartment (transcellular shift), increased renal phosphate excretion, or any combination of these factors. Complications of acute hypophosphatemia are caused by impaired energy metabolism due to decreased adenosine triphosphate synthesis and compromised tissue oxygenation resulting from depletion of 2,3-diphosphoglycerate, leading to cellular dysfunction in multiple organ systems. Symptomatic hypophosphatemia (at a phosphate level < 0.32 mmol/L) is characterized by the development of respiratory failure, the need for mechanical ventilation, reduced myocardial contractility, rhabdomyolysis, and central nervous system disturbances. Hypophosphatemia is one of the electrolyte disturbances observed in sepsis, refeeding syndrome, insulin therapy for diabetic ketoacidosis, and other conditions associated with high mortality rates. Studies investigating the impact of hypophosphatemia on ICU patients, as well as approaches to its correction, have yielded conflicting results for many years. Currently, the Russian Federation lacks approved pharmaceutical preparations of phosphates for both enteral and parenteral administration. This unavailability precludes the appropriate correction of acute hypophosphatemia in intensive care units, ultimately compromising the quality of medical care and potentially adversely affecting patient outcomes. This review is dedicated to the problem of hypophosphatemia in ICU patients, its influence on outcomes, and the management strategies for this condition.
About the Authors
K. S. Kulikova
National Medical Research Center of Endocrinology named after academician I. I. Dedov; N. P. Bochkov Medical and Genetic Research Center; Russian Children’s Clinical Hospital – branch of the Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Kulikova Kristina S., Cand. of Sci. (Med.), Pediatric Endocrinologist of the Department of Hereditary Diseases and Endocrinopathies of Early Childhood; Associate Professor of the Department of Genetics of Endocrine Diseases; Pediatric Endocrinologist
11, Dmitriya Ul`yanova str., Moscow, 117292
1, Moskvorechye str., Moscow, 115478
117, Leninsky pr., Moscow, 119571
D. K. Azovskiy
Moscow Multidisciplinary Clinical Center «Kommunarka»
Russian Federation
Russian Federation
Azovskiy Dmitry K., Dr. of Sci. (Med.), Head of the Anesthesiology and Intensive Care Center, Anesthesiologist and Intensivist
8, Sosensky Stan str., Moscow, 108814
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Review
For citations:
Kulikova K.S., Azovskiy D.K. Hypophosphatemia in critical care in adult patients (literature review). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2026;23(1):118-127. (In Russ.) https://doi.org/10.24884/2078-5658-2026-23-1-118-127
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