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Differential Diagnosis: Hypophosphatemia

Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP, Cornell University

Internal Medicine

|January 2020|Peer Reviewed

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Differential Diagnosis: Hypophosphatemia

Following are differential diagnoses, listed in order of likelihood, for patients presented with hypophosphatemia.

  • Transcellular shifts
    • Diabetes mellitus, particularly diabetic ketoacidosis, following insulin therapy (common)
    • Respiratory alkalosis due to hyperventilation caused by hypoxia, stress, anxiety, salicylate toxicity, CNS disease, fever, heat stroke, sepsis, and/or gram-negative infections
    • Refeeding syndrome
  • Decreased absorption
    • Vomiting/diarrhea, particularly secondary to severe malabsorptive disease
    • Anorexia
    • Vitamin D deficiency
    • Low-phosphorus diet
    • Overdose of phosphate-binding antacids 
    • Steatorrhea
    • Following significant intestinal resection
  • Increased renal excretion
    • Diabetes mellitus
    • Diuretics
    • Corticosteroids
    • Hyperadrenocorticism
    • Hypercalcemia of malignancy
    • Primary hyperparathyroidism
    • Renal tubular disorder (eg, Fanconi syndrome)
    • Hyperaldosteronism
    • Increased phosphatonins (eg, following renal transplantation [cats])
    • Eclampsia
    • Recovery from hypothermia
    • Following hepatic resection
  • Miscellaneous
    • Hepatic lipidosis (cats)
  • Pseudohypophosphatemia
    • Paraproteinemia


For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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