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Test Catalog

Test ID: PHOS    
Phosphorus (Inorganic), Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosis and management of a variety of disorders including bone, parathyroid, and kidney disease

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Of the phosphorus contained in the body, 88% is localized in bone in the form of hydroxyapatite. The remainder is utilized during intermediary carbohydrate metabolism and bound to physiologically important substances such as phospholipids, nucleic acids, and adenosine triphosphate (ATP). Phosphorus exists in blood in the form of inorganic phosphate and organically bound phosphoric acid. The small amount of extracellular organic phosphorus is found exclusively in the form of phospholipids. Serum contains approximately 2.5 to 4.5 mg/dL of inorganic phosphate (the fraction measure in routine biochemical assays). Serum phosphate concentrations are dependent on dietary intake and regulation by hormones such as parathyroid hormone (PTH) and 1,25 vitamin D, and systemic acid base status and may vary widely.

 

Hypophosphatemia may have 4 general causes: shift of phosphate from extracellular to intracellular, renal phosphate wasting, loss from the gastrointestinal tract, and loss from intracellular stores.

 

Hyperphosphatemia is usually secondary to an inability of the kidneys to excrete phosphate and is common in patients with chronic kidney disease stage 4 or greater. Acute hyperphosphatemia can occur as a result of tissue breakdown such as rhabdomyolysis. Other possible contributory factors are increased intake, especially in combination with chronic kidney disease, or a shift of phosphate from tissues into the extracellular fluid.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Males

1-4 years: 4.3-5.4 mg/dL

5-13 years: 3.7-5.4 mg/dL

14-15 years: 3.5-5.3 mg/dL

16-17 years: 3.1-4.7 mg/dL

> or =18 years: 2.5-4.5 mg/dL

Reference values have not been established for patients that are less than 12 months of age.

Females

1-7 years: 4.3-5.4 mg/dL

8-13 years: 4.0-5.2 mg/dL

14-15 years: 3.5-4.9 mg/dL

16-17 years: 3.1-4.7 mg/dL

> or =18 years: 2.5-4.5 mg/dL

Reference values have not been established for patients that are less than 12 months of age.

Interpretation Provides information to assist in interpretation of the test results

Hypophosphatemia is relatively common in hospitalized patients. Serum concentrations of phosphate between 1.5 and 2.4 mg/dL may be considered moderately decreased and are not usually associated with clinical signs and symptoms. Levels below 1.5 mg/dL may result in muscle weakness, hemolysis of red cells, coma, bone deformity, and impaired growth.

 

The most acute problem associated with rapid elevations of serum phosphate levels is hypocalcemia with tetany, seizures, and hypotension. Soft tissue calcification is also an important long-term effect of high phosphorus levels.

 

Phosphorus levels below 1.0 mg/dL are potentially life-threatening and are considered a critical value in the Mayo Health System.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Phosphorus has a very strong biphasic circadian rhythm. Values are lowest in the morning, peak first in the late afternoon and peak again in the late evening. The second peak is quite elevated and results may be outside the reference range.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Delaney MP, Lamb EJ: Kidney disease. In: Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1280-1283

2. Agarwal R, Knochel JP: Hypophosphatemia and hyperphosphatemia. In: Brenner BM, ed. The Kidney. 6th ed. WB Saunders Company; 2000:1071-1125

3. Yu GC, Lee DBN: Clinical disorders of phosphorus metabolism. West J Med. 1987 Nov;147(5):569-576

4. Koumakis E, Cormier C, Roux C, Briot K: The causes of hypo- and hyperphosphatemia in humans. Calcif Tissue Int. 2021 Jan;108(1):41-73. doi: 10.1007/s00223-020-00664-9