Phosphorus is one of the most abundant elements in the human body. Most phosphorus in the body is complexed with oxygen as phosphate.
About 85% of the about 500 to 700 g of phosphate in the body is contained in bone, where it is an important constituent of crystalline hydroxyapatite. In soft tissues, phosphate is mainly found in the intracellular compartment as an integral component of several organic compounds, including nucleic acids and cell membrane phospholipids.
Phosphate is also involved in aerobic and anaerobic energy metabolism. Red blood cell 2,3-diphosphoglycerate (2,3-DPG) plays a crucial role in oxygen delivery to tissue. Adenosine diphosphate (ADP) and adenosine triphosphate (ATP) contain phosphate and use chemical bonds between phosphate groups to store energy.
Phosphate is a major intracellular anion but is also present in plasma.
The normal serum phosphate concentration in adults ranges from 2.5 to 4.5 mg/dL (0.81 to 1.45 mmol/L). Phosphate concentration is 50% higher in infants and 30% higher in children, possibly because of the important roles the phosphate-dependent processes play in growth.
Phosphate concentration can become
Too high (hyperphosphatemia Hyperphosphatemia Hyperphosphatemia is a serum phosphate concentration > 4.5 mg/dL (> 1.46 mmol/L). Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. Clinical... read more ), usually as a result of chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more
, hypoparathyroidism Hypoparathyroidism Hypoparathyroidism is a deficiency of parathyroid hormone often caused by an autoimmune disorder or by iatrogenic damage or removal of the glands during thyroidectomy or parathyroidectomy. Symptoms... read more , metabolic acidosis Metabolic Acidosis Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly... read more , or respiratory acidosis Respiratory Acidosis Respiratory acidosis is primary increase in carbon dioxide partial pressure (Pco2) with or without compensatory increase in bicarbonate (HCO3−); pH is usually low but may be near... read more Too low (hypophosphatemia Hypophosphatemia Hypophosphatemia is a serum phosphate concentration < 2.5 mg/dL (0.81 mmol/L). Causes include alcohol use disorder, burns, starvation, and diuretic use. Clinical features include muscle weakness... read more ), usually as a result of alcohol use disorder Alcohol Use Disorder and Rehabilitation Alcohol use disorder involves a pattern of alcohol use that typically includes craving and manifestations of tolerance and/or withdrawal along with adverse psychosocial consequences. Alcoholism... read more , burns Burns Burns are injuries of skin or other tissue caused by thermal, radiation, chemical, or electrical contact. Burns are classified by depth (superficial and deep partial-thickness, and full-thickness)... read more
, starvation, or diuretic use
The typical American diet contains about 800 to 1500 mg of phosphate. The amount in stool varies depending on the amount of phosphate-binding compounds (mainly calcium) in the diet. Also, like calcium, gastrointestinal phosphate absorption is enhanced by vitamin D.
Renal phosphate excretion roughly equals gastrointestinal absorption to maintain phosphate balance. Phosphate depletion can occur in various disorders and normally results in conservation of phosphate by the kidneys. Phosphate in bone serves as a reservoir, which can buffer changes in plasma and intracellular phosphate.
