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Severe hypophosphataemia: a rare cause of postoperative muscle weakness
  1. Aarti Narayan1,
  2. Arun Subramanian2
  1. 1Division of Pulmonary & Critical Care, Mayo Clinic, Rochester, MN, USA
  2. 2Division of Anesthesiology, Mayo Clinic, Rochester, MN, USA
  1. Correspondence to Aarti Narayan, narayan.aarti{at}


We report a case of severe generalised muscle weakness in a 66-year-old man who underwent revision of left knee arthroplasty. On postoperative day 1, he developed non-focal muscle weakness and shortness of breath which progressed over a 6-hour period. Serum phosphorus level was severely low at 0.5 mg/dL, along with mild degree of hypokalaemia, hypocalcaemia and hypomagnesaemia. His symptoms completely resolved after emergent phosphorus replacement. The authors believe this case is of educational interest to physicians as generalised muscle weakness is an uncommon presentation of severe hypophosphataemia. In a postoperative setting, hypophosphataemia is often multifactorial, thought to result from combination of perioperative catecholamine surge, administration of saline, diuretics, glucose and antacids, poor oral intake and respiratory alkalosis secondary to pain. We report this case to raise awareness among physicians on severe phosphate imbalance as the primary aetiology for acute generalised muscle weakness and respiratory failure, especially after a surgery.

  • adult intensive care
  • fluid electrolyte and acid-base disturbances
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  • Contributors Both authors contributed to the design of work, revising it critically for important intellectual content and final approval of the version to be published. Both authors read and approved the final manuscript. AN was involved in the drafting of the article.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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