Hyperphosphatemia - Differential Diagnosis Algorithm

Transcellular Shift:

 • Rhabdomyolysis

 • Tumor Lysis

 • Metabolic or Respiratory Acidosis

 • Insulin Deficiency

Decreased Excretion FE PO4 < 20%:

 • Renal Disease

 • Hypoparathyroidism

 • Pseudo-hypoparathyroidism

 • Acromegaly

 • Bisphosphonate Therapy

Increased Intake / Absorption - Normally in Context of Impaired Renal Function:

 • Hypervitaminosis D

 • Phosphate Supplementation

 • Phosphate Containing Enemas/Laxatives

Pseudo-hyperphosphatemia:

 • Multiple Myeloma Hyperbilirubinemia

 • Hemolysis

 • Hyperlipidemia

 • Tumor Lysis



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