Electrolyte imbalance in alcoholic patients

Q:  In an alcoholic patient, deficiency of which of the following electrolytes may become evident only after 24-36 hours of admission, and can be life-threatening?

A) Calcium
B) Magnesium
C) Potassium
D) Phosphate
E) Chloride


Answer: D

This late hypophosphatemia in alcoholic patients may occur due to various reasons, mainly

1.  Patients with alcohol abuse are usually treated with dextrose-containing solutions on admission to a hospital. Dextrose induces insulin release, which increases phosphate intake by the cells.

2. Refeeding syndrome after admission to the hospital also exacerbates the movement of phosphate into the cell.

3. As patient starts having withdrawal from alcohol, hyperventilation (respiratory alkalosis) may ensue, which leads to movement of phosphate into the cell. 

#electrolytes


References:

1. Knochel JP. Hypophosphatemia in the alcoholic. Arch Intern Med 1980; 140:613. 

2. Marinella MA. Refeeding syndrome and hypophosphatemia. J Intensive Care Med 2005; 20:155.