Phosphate Disorders Hypophosphatemia Mnemonics Flashcards
What does the mnemonic ‘SHIFT DIP’ represent in the context of hypophosphatemia?
Causes of Hypophosphatemia:
* Shift (intracellular): Glucose, insulin, refeeding
* Hyperparathyroidism (PTH ↑ phosphate excretion)
* Intestinal malabsorption (celiac, vitamin D deficiency)
* FGF-23 disorders (XLH, ADHR, TIO)
* Toxins/drugs (diuretics, chemotherapy, alcohol)
* Diuretics (loop, thiazides, CA inhibitors)
* Iatrogenic (TPN, IV iron)
* Prostaglandins (rare, e.g., NSAIDs in Fanconi syndrome)
Mnemonic for remembering causes of hypophosphatemia
What does the mnemonic ‘CRAMPS’ indicate regarding symptoms of severe hypophosphatemia?
Symptoms of Severe Hypophosphatemia:
* Cardiac dysfunction (↓ output, arrhythmias)
* Rhabdomyolysis (muscle breakdown)
* Anemia/hemolysis (↓ 2,3-DPG)
* Mental status changes (confusion, seizures)
* Pulmonary failure (weak diaphragm)
* Skeletal (osteomalacia, fractures)
Mnemonic for remembering symptoms of severe hypophosphatemia
What does the mnemonic ‘P.R.E.P’ refer to in the treatment approach for hypophosphatemia?
Treatment Approach:
* Phosphate replacement (IV for severe, oral for mild/moderate)
* Remove cause (stop binders, correct refeeding)
* Evaluate complications (check Ca²⁺, Mg²⁺, K⁺)
* Prevent recurrence (diet, monitor FGF-23 disorders)
Mnemonic for treatment approach in hypophosphatemia
What does the mnemonic ‘FAT X’ signify in relation to FGF-23-mediated disorders?
FGF-23-Mediated Disorders:
* FGF-23 high (XLH, ADHR, ARHR, TIO)
* Active vitamin D low (calcitriol ↓ due to FGF-23)
* Treatment: Phosphate + calcitriol (except HHRH)
* X-linked (XLH = most common inherited form)
Mnemonic for remembering FGF-23-mediated disorders
What risks does the mnemonic ‘STARVED’ highlight in relation to Refeeding Syndrome?
Refeeding Syndrome Risks:
* Starvation → sudden carbs → Shift (phosphate into cells)
* TPN/enteral feeds → Too fast
* ATP depletion → Arrhythmias
* Respiratory failure (weak muscles)
* Vitamins/electrolytes needed (thiamine, K⁺, Mg²⁺)
* Early monitoring (glucose, phosphate)
* Death (if untreated)
Mnemonic for remembering risks associated with Refeeding Syndrome
What does the mnemonic ‘D.I.U.R.E.T.I.C.S’ represent in the context of drugs causing hypophosphatemia?
Key Drugs Causing Hypophosphatemia:
* Diuretics (loop, thiazides)
* Iron (IV → ↑ FGF-23)
* Uricosurics (rare)
* Reflux meds (antacids bind phosphate)
* EtOH (alcoholism)
* Tenofovir (Fanconi syndrome)
* Ifosfamide (tubular toxicity)
* Chemo (cisplatin)
* Steroids (↑ urinary loss)
Mnemonic for remembering drugs that can cause hypophosphatemia
What key features are compared in the mnemonic ‘XLH vs. PHPT’?
Lab Findings in XLH vs. Primary Hyperparathyroidism:
* FGF-23: XLH - Extremely high, PHPT - Low/Normal
* PTH: XLH - High (late), PHPT - Primarily high
* Ca²⁺: XLH - Normal, PHPT - High
* 1,25(OH)₂D₃: XLH - Low, PHPT - High
Mnemonic for comparing lab findings in XLH and Primary Hyperparathyroidism
What does the ‘30-20-10 Rule’ correspond to in IV phosphate dosing?
IV Phosphate Dosing:
* <1 mg/dL: 30 mmol (40–60 kg), 40 mmol (61–80 kg), 50 mmol (81–120 kg)
* 1–1.7 mg/dL: 20, 30, 40 mmol (same weights)
* 1.8–2.2 mg/dL: 10, 15, 20 mmol
Mnemonic for IV phosphate dosing based on serum phosphate levels
What does the mnemonic ‘DROP Pi’ stand for?
D - Decreased absorption, R - Renal losses, O - Overmedication (drugs), P - Phosphate shifts (intracellular), Pi - Phosphate
This mnemonic helps remember the main categories of causes of hypophosphatemia.
What does ‘GIRL RAP’ represent in the context of intracellular shifts?
G - Glucose administration, I - Insulin therapy, R - Respiratory alkalosis, L - Lactate (from catecholamines), R - Refeeding syndrome, A - Alkalosis, P - Proliferation (rapid cell growth)
This mnemonic assists in recalling specific causes of intracellular phosphate shifts.
What does the mnemonic ‘BAD TAP’ indicate for decreased absorption?
B - Binders (antacids), A - Absorption issues (malabsorption), D - Deficiency (vitamin D), T - Tenapanor, A - Altered gut (surgery/resection), P - Poor intake
This mnemonic highlights various factors that can lead to decreased phosphate absorption.
What does ‘FAN PHR’ stand for regarding renal losses?
F - FGF-23 disorders, A - Acquired tubular defects, N - NHERF mutations, P - PTH excess, H - Hereditary disorders, R - Renal transplantation
This mnemonic is used to remember the causes of renal phosphate losses.
What does the mnemonic ‘DICTATES’ reference in drug causes of hypophosphatemia?
D - Diuretics, I - Iron (IV), C - Chemo agents (cisplatin), T - Tenofovir, A - Antivirals (acyclovir), T - Tetracyclines, E - EtOH (alcohol), S - Steroids
This mnemonic helps recall various drugs that can contribute to hypophosphatemia.
What does ‘HAD MIT’ signify in miscellaneous causes?
H - Hypokalemia, A - Alcoholism, D - DKA, M - Metabolic acidosis, I - Iron overload, T - Toxic shock syndrome
This mnemonic includes various miscellaneous factors that can cause hypophosphatemia.
What does ‘3D FISH’ denote in the context of hypophosphatemia?
3D: Decreased intake, Decreased absorption, Drugs; FISH: FGF-23 disorders, Intracellular shifts, Secondary hyperPTH, Hereditary disorders
This mnemonic provides a quick recall of the major categories and specific causes of hypophosphatemia.
What does the mnemonic ‘PHEX FLEX’ stand for in relation to X-linked hypophosphatemia?
P - PHEX gene mutation
H - Hypophosphatemia
E - Elevated FGF-23
X - X-linked dominant
F - Fractures/rickets
L - Low 1,25(OH)2D3
E - Early childhood onset
X - X-ray abnormalities
This mnemonic helps remember key aspects of XLH genetics and clinical features.
What does the mnemonic ‘FLEX Your Bones’ represent for XLH features?
F - FGF-23 high
L - Low phosphate
E - Early bowing legs
X - X-linked inheritance
Y - Young onset (age <2)
O - Osteomalacia
U - Urinary phosphate wasting
R - Rickets
B - Burosumab treatment
O - Oral phosphate needed
N - Normal calcium
E - Enamel defects
S - Short stature
This mnemonic highlights the clinical features and treatment options for XLH.
What does the mnemonic ‘BOWED LEGS’ indicate regarding the clinical presentation of XLH?
B - Bone pain
O - Osteomalacia
W - Walking delay
E - Enlarged wrists
D - Dental abscesses
L - Low phosphate
E - Elevated alkaline phosphatase
G - Growth retardation
S - Short stature
This mnemonic summarizes the common clinical symptoms associated with XLH.
What does the mnemonic ‘XLH LABS’ refer to in laboratory findings for XLH?
X - X-linked
L - Low phosphate
H - High FGF-23
L - Low/normal calcium
A - Alk phos elevated
B - Burosumab works
S - Serum PTH normal
This mnemonic helps remember the key laboratory findings associated with XLH.
What components are included in the mnemonic ‘PHEX-MAN’ for treatment of XLH?
P - Phosphate supplements
H - High-dose calcitriol
E - Early intervention
X - X-ray monitoring
M - Monitor kidneys
A - Anti-FGF23 (burosumab)
N - Nutrition support
This mnemonic outlines the treatment strategies for managing XLH.
What are the two key effects of FGF-23 as described in the mnemonic ‘FGF-23 Effects’?
1) ↓ renal phosphate reabsorption
2) ↓ 1,25(OH)2D3 production
This mnemonic emphasizes the physiological impacts of FGF-23 in XLH.
What does the mnemonic ‘FGF-23 UNCUT’ represent for ADHR?
F: FGF-23 gene mutation
G: Gain-of-function (activating)
F: Failure of cleavage → ↑ intact FGF-23
23: (FGF-23)
U: Uncleaved protein accumulates
N: Normal PTH
C: Calcitriol low
U: Unpredictable onset (incomplete penetrance)
T: Treatment (phosphate + calcitriol)
This mnemonic highlights the key features of Autosomal Dominant Hypophosphatemic Rickets.
What does the mnemonic ‘ADULT VARIABLE’ stand for in ADHR?
A: Autosomal Dominant
D: Delayed onset possible
U: Uncleaved FGF-23
L: Lower limb deformities
T: Treatment with phosphate/D
V: Variable presentation
A: Adult onset possible
R: Rickets
I: Improves sometimes at puberty
A: Alkaline phosphatase ↑
B: Bone pain
L: Low phosphate
E: Elevated FGF-23
This mnemonic summarizes the clinical features and treatment of Autosomal Dominant Hypophosphatemic Rickets.
What does the mnemonic ‘DEEP ARHR’ signify for ARHR?
D: DMP1/ENPP1 genes
E: Elevated FGF-23
E: Early childhood onset
P: Phosphate supplements needed
A: Autosomal Recessive
R: Rickets severe
H: Hypophosphatemia
R: Requires calcitriol
This mnemonic encapsulates the essential characteristics of Autosomal Recessive Hypophosphatemic Rickets.
