Persistent, progressive hypophosphataemia after voluntary hyperventilation

Abstract

Hyperventilation (HV) and respiratory alkalosis are associated with hypophosphataemia, although the extent and duration of HV required to produce changes in serum phosphate levels are not known. We sought to characterize the effects of HV, with or without dextrose loading, on serum phosphate levels and other biochemical parameters. HV was monitored by controlling the end-tidal partial pressure of carbon dioxide (Petco2). The effect of dextrose was studied because infusion of a glucose load is known to promote a fall in serum phosphate via stimulation of glycolysis. Eight healthy volunteers were enrolled in four study protocols: (1) HV for 20 min to a Petco2 of 25–30 mmHg (mild); (2) HV for 20 min to a Petco2 of 15–20 mmHg (severe); (3) mild HV with intravenous dextrose loading, and (4) dextrose loading alone. Periodic measurements of serum phosphate, venous pH, serum 2,3-diphosphoglycerate (2,3-DPG) and other parameters were made. Serum phosphate fell during HV and continued to decline after cessation of HV. Dextrose loading alone caused a fall in serum phosphate that continued for at least 30 min after cessation of the infusion (P < 0.0002). HV combined with dextrose resulted in a greater decline in serum phosphate than either variable alone (P = 0.003). The maximal decline in serum phosphate occurred in severe HV, with a mean decrease of 0.38 mmol/l at 20 min after cessation of HV (P < 0.0001). Serum phosphate was still significantly lowered compared with baseline at 90 min after cessation of HV (P = 0.001). Other significant changes seen with HV included a decrease in serum glucose (P < 0.01), a decrease in serum potassium (P < 0.05) and an increase in venous pH (P < 0.007). Serum 2,3-DPG levels did not change significantly in any study protocol. Thus relatively mild acute HV produces significant changes in serum phosphate. In both mild and severe HV this effect is progressive after cessation of HV. This phenomenon has not been shown before, and may have significant clinical implications.