 Welcome to nursing school explain and this video on phosphorus imbalances. So we'll go over hypo and hyperphosphatemia and as a quick reference here normal values of phosphorus in the bloodstream are 2.4 to 4.4. Keep in mind as always to check the reference levels for the particular lab that you are working with to make sure that these are the same so that you know if your patients values are within or not within the normal limits. So phosphorus is a major intracellular electrolyte so it mostly occurs in the intracellular fluid. It is also important for bones and teeth regulation and that has to do with it having an inverse relationship to calcium and we'll get to that in a moment. And phosphorus is also responsible for energy metabolism as an ATP adenosine triphosphate so that's a major player here as well. It also helps us in our acid based buffering system and then is important for muscle contraction and relaxation to a certain degree and that always pertains to cardiac skeletal and smooth muscle. It doesn't affect the muscles as much as potassium, magnesium as well as calcium but because of its inverse relationship with calcium we have to kind of keep that in the back of our minds. And phosphoid levels are regulated by the parathyroid gland which are four small glands that sit on the back of the thyroid gland and it has like I already mentioned an inverse relationship with calcium and the way that the parathyroid gland regulates our phosphorus as well as calcium levels is if the gland detects that serum calcium levels are low it'll release parathyroid hormone PTH which then will increase the calcium absorption or it will pull calcium from the bone and decrease phosphate levels because we know they have this inverse relationship and then it also will increase magnesium levels or magnesium levels usually move in the same direction as calcium levels. And then vice versa if the parathyroid gland down regulates the release of parathyroid hormone calcium levels go down phosphorus levels go up and magnesium levels go down so always keep these relationships of these electrolytes in mind because a lot of them they kind of work together and they're responsible for or more than one electrolyte is responsible for certain functions. So for causes of hypophosphatemia primary cause is elevated parathyroid hormone and that is because of primary hyperparathyroidism so now when the parathyroid gland is over functioning it over releases that parathyroid hormone which then increases calcium and decreases phosphorus levels leading to hypophosphatemia but TP and total parenteral nutrition can also lead to hypophosphatemia as well as an increased intake in calcium and magnesium because like we talked over here they have this inverse relationship vomiting diarrhea as well as malnutrition and alcohol withdrawal are other causes of hypophosphatemia. In terms of high phosphorus levels again it's regulated by the parathyroid so if we have low parathyroid hormone the phosphorus level will go up as we talked about here earlier any kind of increased phosphorus in the diet and then infants fed cow's milk so cow's milk is a major source of phosphorus and the infants just don't have the ability to digest or process it and then it can lead to hypophosphatemia which is not good for infants. Also phosphorus containing laxatives so think about patients maybe who suffer from chronic constipation or who have some sort of an eating disorder with binging and purging they're at high at risk for hypophosphatemia and then patients with chronic kidney disease also patients taken by phosphonates which are medications that we use in the treatment of osteoporosis and that has to do with when the patient has osteoporosis they're lacking calcium so we're giving them these bifosphonates to help drive the calcium from the serum into the bone to strengthen the bone but in turn because of this inverse relationship with calcium phosphorus levels can go up and then any kind of decreased intake in calcium and magnesium can lead to increase in phosphorus because of this inverse relationship we talked about here. So then over here for signs and symptoms of phosphate imbalances always think muscles and bones so hypophosphatemia can lead to muscle weakness and decreased deep tendon reflexes, peristasia such as numbness and tingling as well as I just discussed osteoporosis and fractures because of the calcium that is increased in the bloodstream because of that and it can also lead to a decrease in respiratory rate because this muscle weakness can extend to the respiratory muscles and decrease that respiratory rate and drive and then on the opposite side for hyperphosphatemia we have this telltale sign of uremic frost and that has to do with chronic kidney disease so watch my video about chronic kidney disease how that leads to hyperphosphatemia but uremic frost is this kind of phosphorus that gets deposited in the skin so when there's too much phosphorus on board the body will kind of try and deposit get rid of it deposited in the skin and many times patients with chronic kidney disease they kind of have this grayish discoloration that can sometimes even be a little bit flaky and that is that phosphorus deposited in their skin and we also refer to it as uremic frost. With hyperphosphatemia we also need to think about positive schvastik and trousseau sign so look up those signs if you're not familiar it can lead to an increase in the deep tendon reflexes as well as muscle cramps all the way to tetany and then peristegia specifically in the fingers and so around the mouth so because calcium and phosphorus have this inverse relationship signs and symptoms of hyperphosphatemia will coincide with signs and symptoms of hyperchalcemia vice versa high phosphorus level signs and symptoms will be the same or very similar to low calcium levels because they have this inverse relationship so when you're getting confused with deep tendon reflexes for example as many times have there are many times questions on exams that pertain to that so just think about memorize one and then you can always think about others as well and the same applies to the deep tendon reflexes to phosphorus calcium as well as magnesium because magnesium can alter deep tendon reflexes too so they always move calcium and magnesium deep tendon reflexes always move in the opposite direction as we have here for phosphorus because of this inverse relationship treatment so if we have low levels of phosphorus we're going to increase dietary sources decrease dietary calcium because we know that those work together and then in severe cases we can also give the patient IV sodium phosphate if phosphate levels are too high we need to decrease the levels on the diet increase the patient's calcium maybe put them on diuretics to hopefully get rid of the elevated phosphorus in the in the bloodstream through the kidneys and then phosphate binders so patients specifically again with chronic kidney disease because we know that there is this risk of this hyperphosphatemia with that manifests itself with this uremic frost they take these phosphate binders to help them bind their the phosphate through the GI and then excrete them that way nursing care as always we want to monitor milder signs because we know it can affect those we want to monitor their neuromuscular functions so all the for peresthesia, synonymous and tingling muscle weaknesses as well as deep tendon reflexes we want to put them on a heart monitor because phosphorus in particular doesn't really have any signs and symptoms that are listed here for heart rate or EKG changes but because it is so closely related to calcium levels that's always a good idea we want to check patients lab phosphorus calcium magnesium as we talked about we want to increase weightbearing exercises in hypophosphatemia again because it can lead to osteoporosis all the way to fractures and weightbearing exercises will help counteract that and then we want to closely observe patients status post thyroidectomy or any kind of neck surgery to see if something has happened to the parathyroid glands that sit on the back of the thyroid here and see if we have an imbalances now in parathyroid hormone that can alter our calcium and phosphorus ability to balance those two in the serum thanks so much for watching this video on phosphorus imbalances please also check out the other videos about the other electrolyte imbalances in my fluid and electrolyte playlist and I hope to see you soon back right here on nursing school explain thanks for watching