Disorders Of Phosphate Hyperphosphatemia Mnemonics Flashcards
What does the mnemonic ‘PHOSPHATE’ represent in the causes of hyperphosphatemia?
- Pseudohypoparathyroidism
- Hypoparathyroidism
- Oral/IV phosphate (exogenous)
- Secondary to CKD (GFR <30)
- PTH resistance (e.g., familial tumor calcinosis)
- Hemolysis/rhabdomyolysis
- AKI (especially tumor lysis syndrome)
- Thyrotoxicosis (rare)
- Excess vitamin D/bisphosphonates
This mnemonic helps to remember the various causes of high phosphate levels in the blood.
What does the mnemonic ‘BIG LIPS’ signify regarding drugs causing hyperphosphatemia?
- Bisphosphonates
- Immune checkpoint inhibitors (tumor lysis)
- Growth hormone
- Liposomal amphotericin B
- IV/oral phosphate
- Phosphate enemas
- Sodium phosphate laxatives
This mnemonic aids in recalling specific medications that can lead to elevated phosphate levels.
What are the clinical features of hyperphosphatemia represented by the mnemonic ‘CRYSTAL’?
- Calcifications (vascular, soft tissue)
- Renal osteodystrophy (CKD-MBD)
- Yawning (fatigue, nonspecific)
- Seizures (hypocalcemia-induced)
- Tetany/Chvostek’s/Trousseau’s signs
- Arrhythmias (from hypocalcemia)
- Low Ca²⁺ (due to Ca-PO₄ precipitation)
‘CRYSTAL’ helps to remember the complications associated with hyperphosphatemia.
What treatment strategies for hyperphosphatemia are summarized by the mnemonic ‘BIND IT DOWN’?
- Binders (sevelamer, lanthanum, Ca-based)
- Intestinal blockade (tenapanor)
- No phosphate diet (avoid processed foods)
- Dialysis (for severe cases)
- IV saline (for tumor lysis-induced)
- Treat underlying cause (e.g., hypoparathyroidism)
- Diuretics (loop/thiazide in some cases)
- Osteodystrophy management (vitamin D analogs)
- Water restriction (if volume overloaded)
This mnemonic outlines various strategies to manage hyperphosphatemia effectively.
What types of phosphate binders are indicated by the mnemonic ‘CLASh’?
- Calcium-based (Ca acetate/carbonate)
- Lanthanum carbonate
- Aluminum hydroxide (short-term only)
- Sevelamer (HCl/carbonate)
‘CLASh’ is a useful mnemonic for remembering the different classes of phosphate binders.
What does the mnemonic ‘PO₄ Problems’ describe in relation to CKD-MBD?
- PO₄ high → PTH high → Poor bones (osteodystrophy)
This mnemonic summarizes the triad of phosphate-related issues in Chronic Kidney Disease - Mineral and Bone Disorder.
What mnemonic helps remember the causes of hyperphosphatemia?
PHOSPHATE OVERLOAD
Causes include Pseudohypoparathyroidism, Hypoparathyroidism, Oral/IV phosphate, Secondary to CKD, PTH resistance, Hemolysis/rhabdo, AKI, Thyrotoxicosis, Excess vitamin D, Overuse of phosphate enemas, Vitamin D intoxication, End-stage renal disease, Renal failure, Loop diuretic withdrawal, Osteolytic metastases, Acidosis, and Drugs.
What does the acronym ‘CRUSH’ stand for in relation to Tumor Lysis Syndrome?
CRUSH
Chemotherapy-induced, Rapid cell lysis, Uric acid ↑, Seizures (hypocalcemia), Hyperphosphatemia/K⁺.
What are the components of the CKD-MBD triad represented by ‘PO4 PROBLEMS’?
PO4 PROBLEMS
PO4 high, PTH high, Poor bones (osteodystrophy).
What does ‘CLASH’ refer to in the context of phosphate binders?
CLASH
Calcium-based, Lanthanum, Aluminum (short-term), Sevelamer, Hydroxide (aluminum).
What mnemonic represents the effects of FGF-23?
FGF-23 LOWERS
Fibroblast growth factor 23, Guts (↓ intestinal PO4 absorption), Fails in CKD, 23 → ↓ 1,25(OH)2D3, Lowers PO4 reabsorption, Osteocyte-derived, Worsens with ↓ Klotho, Elevated in CKD, Renal phosphate wasting, Secondary hyperparathyroidism.
What does ‘PHAT’ indicate regarding electrolyte changes in TLS?
PHAT
Phosphate ↑, Hypocalcemia, Acidosis, Too much K⁺ (hyperkalemia).
What features are summarized by ‘G-F-K’ in FTC?
G-F-K
GALNT3 mutation, FGF-23 dysfunction, Klotho resistance.
How does AKI differ from CKD in relation to phosphate levels?
AKI: Sudden PO4 ↑ (think tumor lysis/rhabdo); CKD: Chronic FGF-23/Klotho dysfunction
This illustrates the different mechanisms affecting phosphate levels in acute and chronic conditions.
What is the preferred phosphate binder for rapid control in acute conditions?
Aluminum hydroxide
Useful for rapid PO4 control in acute settings.
What is the emergency treatment for Tumor Lysis Syndrome?
Rasburicase > allopurinol
Rasburicase is preferred for faster uric acid reduction.
What are the diagnostic criteria for FTC?
Normal PTH + high PO4 + soft tissue calcifications
These findings are indicative of Fibroblast Transformation Condition (FTC).
In the comparison of Tumor Lysis Syndrome and Rhabdomyolysis, what does ‘↑↑↑’ indicate for phosphate levels?
Tumor Lysis: ↑↑↑; Rhabdomyolysis: ↑↑
This reflects the severity of phosphate elevation in both conditions.
What is the key marker for Rhabdomyolysis compared to Tumor Lysis Syndrome?
Rhabdomyolysis: CK ↑↑↑; Tumor Lysis: Uric acid ↑
This distinguishes the two conditions based on laboratory findings.
What is the typical calcium level change in Tumor Lysis Syndrome?
↓↓
This indicates hypocalcemia, which is a common complication.
What is the urine finding characteristic of Rhabdomyolysis?
Myoglobinuria
This is due to the release of myoglobin from damaged muscle tissue.
