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| Categories | Specific sources | Patient data |
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| Pseudohyperphosphatemia | Heparin | Blood drawn by routine phlebotomy not via heparinized central line; patient not on heparin |
| Paraproteinemia | Paraproteinemia not checked in a young patient without any suspicious signs/symptoms |
| Hyperlipidemia | Total cholesterol 138 mg/dL, low density lipoprotein 71 mg/dl, high density lipoprotein 53 mg/dL, triglycerides 70 mg/dL |
| Liposomal amphotericin | Patient was receiving liposomal amphotericin |
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| Ingestion | Food source | Patient receives hospital food, hyperphosphatemia from food ingestion is unlikely |
| Phosphate-containing medications (e.g., accidental ingestion of phosphate-containing enemas) | |
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| Gastrointestinal absorption | Hypervitaminosis D | Vitamin D, 25-OH level 33 pg/mL |
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| Cellular shift | Cell death (e.g., rhabdomyolysis, hemolysis, tumor lysis, and bowel infarction) | Clinical exam was benign lactate dehydrogenase 106 U/L and creatinine phosphokinase 21 U/L |
Metabolic acidosis (e.g., lactic acidosis and diabetic ketoacidosis)
Chronic respiratory alkalosis | Venous blood gas was consistent with mild normal anion gap metabolic acidosis (which resolved after recovery of kidney function) and chronic respiratory alkalosis. Respiratory alkalosis was likely associated with pregnancy. See discussion in text regarding contribution of patient’s acid-base disturbances to hyperphosphatemia. |
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| Excretion | Reduced kidney excretion (e.g., GFR <30 ml/min/1.73 m2 | Patient’s estimated GFR >> 30 ml/min/1.73 m2 |
| Hypoparathyroidism, parathyroid hormone resistance | Parathyroid hormone 26 pg/ml; serum calcium was in normal range after correction for hypoalbuminemia. Hypoparathyroidism was unlikely |
Drug-induced (e.g., bisphosphonates)
Others: acromegaly, familial tumoral calcinosis, reduced fibroblast growth factor-23 (FGF-23) level or function | Patient was not receiving any bisphosphonates. Conditions such as acromegaly and familial tumoral calcinosis were unlikely contributory due to the acute presentation of hyperphosphatemia. FGF-23 level was also not checked due to low suspicion and diagnosis of pseudohyperphosphatemia was already established. |
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