Hyperphosphatemia from lipid emulsion in a patient on total parenteral nutrition

The clinical course of a patient is described in whom hyperphosphatemia occurred on total parenteral nutrition with lipid emulsion providing half of the nonnitrogenous caloric support. Renal insufficiency, hypoparathyroidism, pseudohypoparathyroidism, and severe catabolism are excluded as causes of this hyperphosphatemia. Changes in serum phosphate are attributed to metabolism of phospholipid present in the lipid emulsion, the sole phosphate source in this patient. These observations suggest that the phosphate of phospholipids can contribute significantly to the metabolic pool of inorganic phosphate. Lipid emulsion, most commonly thought of as a major caloric source, should not be neglected when one is confronted with hyperphosphatemia during total parenteral nutrition.