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Hypophosphataemia: an important cause of collapse
David M Williams1,2, Natasha Shrikrishnapalasuriyar1, David E Price1
1Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, UK.
BMJ Case Reports
|July 20, 2018
Summary
Severe hypophosphatemia, a critical phosphate deficiency, caused a patient
Area of Science:
- Clinical Medicine
- Internal Medicine
- Emergency Medicine
Background:
- A 44-year-old civil servant, typically healthy, experienced sudden collapse.
- The patient reported headache and facial paresthesia preceding the collapse.
- He was on citalopram for depression.
Observation:
- Upon emergency department arrival, the patient presented with a Glasgow Coma Scale (GCS) of 4/15.
- Laboratory results indicated severe hypophosphatemia (phosphate 0.19 mmol/L) with no other electrolyte disturbances.
- No underlying cause for the severe hypophosphatemia was identified during initial investigations.
Findings:
- Intravenous phosphate repletion led to a rapid improvement in the patient's neurological status.
- Glasgow Coma Scale (GCS) score increased to 15 within 4 hours of phosphate administration.
- Follow-up blood tests in the clinic revealed normalized phosphate levels.
Implications:
- Severe hypophosphatemia can manifest as neurological deterioration, including collapse and reduced consciousness.
- Prompt recognition and treatment of hypophosphatemia are crucial for neurological recovery.
- This case highlights the importance of considering electrolyte imbalances in patients presenting with altered mental status.
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