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.
What does the mnemonic ‘DOUBLE RECESSIVE’ represent for ARHR?
D: DMP1 mutations (ARHR1)
O: Osteomalacia
U: Under-mineralized bones
B: Bone deformities
L: Low phosphate
E: ENPP1 mutations (ARHR2)
R: Recessive inheritance
E: Elevated FGF-23
C: Calcitriol needed
E: Early onset
S: Severe rickets
S: Similar to XLH clinically
I: Inherited from both parents
V: Vascular calcifications (ARHR2)
E: Enzyme deficiency (ENPP1)
This mnemonic details the genetic and clinical aspects of Autosomal Recessive Hypophosphatemic Rickets.
What does the comparison mnemonic ‘FGF-23 FAMILY’ highlight?
F: FGF-23 is elevated in all
A: ADHR (Autosomal Dominant)
M: Mutation prevents cleavage (ADHR)
I: Inheritance pattern differs
L: Low phosphate common to all
Y: Youth onset (XLH earliest, ADHR variable, ARHR childhood)
This mnemonic helps in distinguishing the related disorders by summarizing their common and unique features.
What does the mnemonic ‘FIND the TUMOR’ represent in TIO?
F - FGF-23 overproduction
I - Intact FGF-23 (not cleaved)
N - Neoplasms (mesenchymal tumors)
D - DOTATATE PET for detection
T - Tumor secretes phosphatonins
U - Unusual bone pain
M - Middle-aged onset (6th decade)
O - Osteomalacia
R - Resection is curative
What does the mnemonic ‘3C RICKETS’ signify in HHRH Type IIc?
3 - SLC34A3 gene
C - Cotransporter defect
C - Calcitriol HIGH
C - Contraindicated (don’t give more)
R - Renal phosphate wasting
I - Increased calcium
C - Childhood onset
K - Kidney stones risk
E - Elevated 1,25D
T - Treat with phosphate only
S - Serum calcium high
What does the mnemonic ‘FAN-1A’ represent in HHRH Type IIa?
F - Fanconi syndrome
A - Adult presentation
N - NaPi-IIa defect
1 - SLC34A1 gene
A - Autosomal recessive
What does the mnemonic ‘STONES’ signify in NHERF1?
S - SLC34A1 interaction lost
T - Tubular phosphate wasting
O - Osteopenia
N - NHERF1 mutation
E - Elevated 1,25D (but normal Ca)
S - Stones (nephrolithiasis)
What does the mnemonic ‘KLOTHO-P’ represent?
K - Klotho gene defect
L - Large head
O - Overactive FGF-23
T - Treatment-resistant rickets
H - Hyperparathyroidism
O - Osteomalacia
P - Parathyroidectomy needed later
What does the mnemonic ‘PHOSPHATE VIPS’ summarize?
P - PTH (normal in most)
H - Hypophosphatemia
O - Osteomalacia
S - Specific genetic defects
P - Phosphate supplements
H - High/low vitamin D varies
A - Age of onset clues
T - Treatment differences
E - Elevated FGF-23 (or not)
V - Very
I - Important
P - Phosphatonin
S - Syndromes
True or False: The mnemonics help in organizing complex genetic information.
True
Fill in the blank: The mnemonic ‘3C RICKETS’ is particularly effective for distinguishing _______ from TIO.
HHRH
What is the purpose of the ‘FGF-23 Disorders Flowchart’ starting with ‘P-FAD-KT’?
PHEX (XLH) → FGF23 (ADHR) → ARHR (DMP1/ENPP1) → Klotho → TIO
What are the key features highlighted by the mnemonics?
- Highlight key distinguishing features
- Organize complex genetic information
- Emphasize critical treatment differences
- Create memorable clinical associations
- Work for both rapid recall and deeper understanding
