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Acute hypophosphatasemia.

F E McKiernan1, L K Shrestha, R L Berg

  • 1Center for Bone Disease, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI, 54449, USA, mckiernan.fergus@marshfieldclinic.org.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|August 6, 2013
PubMed
Summary
This summary is machine-generated.

A precipitous drop in serum alkaline phosphatase (ALP) indicates severe physiologic stress and is linked to increased short-term mortality. This acute hypophosphatasemia often occurs during critical illness or major medical events.

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Area of Science:

  • Biochemistry
  • Clinical Medicine
  • Medical Diagnostics

Background:

  • Low serum alkaline phosphatase (ALP), or hypophosphatasemia, has a broad and often unfamiliar differential diagnosis.
  • The progression of hypophosphatasemia over time can provide clues to its underlying cause.
  • Understanding the circumstances leading to a significant decrease in ALP is crucial for clinical management.

Purpose of the Study:

  • To identify conditions and clinical scenarios associated with a rapid decline in serum ALP levels below the normal range.
  • To investigate the clinical significance and outcomes of acute hypophosphatasemia.

Main Methods:

  • Retrospective analysis of electronic medical records from Marshfield Clinic.
  • Identification of subjects with at least two serum ALP values ≤ 40 U/L (normal range: 40-125 U/L).
  • Selection of subjects with a precipitous drop in ALP from baseline, defining acute hypophosphatasemia, for further analysis of diagnoses, circumstances, and mortality.

Main Results:

  • Out of over 458,000 subjects, 190 were identified with acute hypophosphatasemia.
  • Acute hypophosphatasemia was associated with major trauma, surgery, multisystem failure, severe anemia, massive blood transfusions, apheresis, hypomagnesemia, and acute caloric restriction.
  • Fifteen percent (28/190) of subjects with acute hypophosphatasemia died within 35 days of their lowest ALP measurement.

Conclusions:

  • Acute hypophosphatasemia is a marker of severe illness or profound physiological stress.
  • This condition is associated with a significantly increased risk of short-term mortality.
  • The pattern of ALP decline can be informative regarding the underlying pathology.