NOT listed as a population at risk for hypophosphatemia?

• A. Malnourished patients aggressively refed
• B. Diabetic ketoacidosis
• C. Chronic alcoholism
• D. Dehydration

Answer: (D)

Hypophosphatemia tends to occur when phosphate is depleted or driven into cells during treatment of malnutrition or metabolic disturbances. In malnourished patients who are aggressively refed, a surge of insulin pushes phosphate into cells to support new tissue synthesis, revealing or worsening low serum phosphate. In diabetic ketoacidosis, large losses of phosphate can occur with diuresis, and phosphate can drop when therapy with insulin shifts phosphate back into cells and metabolism resumes. Chronic alcoholism often involves poor intake and malnutrition, setting the stage for phosphate depletion, especially during refeeding or withdrawal. Dehydration, by contrast, does not inherently cause a drop in phosphate stores or a shift into cells, so it is not a typical population at risk for hypophosphatemia.