HISTORY. Ask patients about their diet and if they have had any nausea, vomiting, diarrhea, or loss of appetite. Inquire about medications, especially aluminum-containing antacids and diuretics. Determine if the patient is a diabetic or has a history of alcoholism, hyperparathyroidism, or a serious recent burn.

PHYSICAL EXAMINATION. Symptoms do not usually occur unless there is total body depletion of phosphorus or the serum level drops below 1 mg/dL. With acute hypophosphatemia, the patient appears apprehensive. Ask if the patient has any chest pain, muscle pain, or paresthesia. With chronic hypophosphatemia, an accurate history may be difficult to obtain because often there is memory loss. The patient may report a history of anorexia, muscle and bone pain, and paresthesia.

Hypophosphatemia generally creates neuromuscular, cardiopulmonary, hematologic, and GI abnormalities. Perform a thorough neuromuscular assessment; assess the patient's hand grasp and leg strength, and note tremors of the extremities. Assess the deep tendon reflexes; often hyporeflexia is found. Neurological deficits include paresthesia, dysarthria, confusion, stupor, seizures, and coma. The patient's voice may be weak and shaky. Assess the patient's ability to swallow and the gag reflex. Auscultate the heart; the pulse may be weak and irregular. Assess the respiratory status, and note if the respirations are rapid and shallow because of impaired diaphragmatic function. Weigh the patient and assess for signs and symptoms of malnutrition, such as pallor, dull hair, poor skin turgor, weight loss, and fatigue.

PSYCHOSOCIAL. The patient with hypophosphatemia may be anxious and concerned about the muscular weakness, paresthesia, and ability to perform activities of daily living. Assess coping skills and family support and ability to assist with care.

Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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