Korean Journal of Nephrology 1994;13(4):747-753.

발열이 있는 급성신우신염에 동반된 저인산염혈증에 관한 임상적 관찰

채동완 , 최호열 , 이재명 , 오흥국 , 김근호 , 전노원 , 이영천 , 노정우

Abstract

Hypophosphatemia is not uncommonly observed in infectious illness and thought to be caused by shift of extracelluar phosphate into cell. Transcellular shift of phosphste is supposed to result from respiratory alkalosis and be augumented by intravenous administration of glucose in some cases. Recently hypophosphatemia was commonly ob- served in malignant neoplastic patients who were re- ceiving intreleukin 2 or tumor necrosis factor which are also known to be important effectors in septice- mia. We tried to evaluate the role of respitory alkalosis, administration of glucose and administration of ibuprofen in hypophosphatemia in infectious illness by measuring plasma P, Ca concentration, arterial blood pH, PcoFEp at admission, plasma P concen- tration after glucose administration and plasma P concentration 90 mimutes after oral administration of 200mg brufen in patients with febrile acute pyelo- nephritis Obtained results were as follows 1) Plasma P concentration of 34 patients at admission were 2.36 ± 0.79mg / dl and hypopho- sphatemia(<25mg/dl)waw abserved in 20 patients (58.8% ). 2) There were no significant relationship between plasma P concentration and arterial blood pH or Pco and no significant differences in incidence of alkalosis or hyperventilation according to the presence of hypophosphatemia 3) Fep of 24 patients at admission was 10.16 ± 7.86% and there was significant correlation be- tween Fep and plasma P concentration (r=0.56; p =0.0043 by Spearman correlation) 4) Plasma P concentration before and after glu- cose administration were respectively 2.39±0.86mg/ dl and 2.54±0.74mg/dl and no significant change was induced by glucose administration 5) Plasma P concentration increased from 2.34± 0.99mg/dl to 2.83±0.97mg/dl(p=0.021 by Wilcoxon signed rank test) and plasma Ca concentration decreased from 8.50±0.47mg/dl to 8.31±0.38mg/dl(p =0.016 by Wilcoxon signed rank test) 90 minutes after oral administration of 200mg of brufen. Our results showed no significant relationships be- tween plasma P concentration and respiratory alkalosis or glucose administration and suggested the role of prostaglandin in the development of hypophos- phatemia in febrile infectionus illness.