In a 40-year-old woman receiving TPN for small-bowel fistula, what finding can be attributed to hypophosphatemia?: (A) Increased cardiac output, (B) Diarrhea, (C) Increased energy production, (D) Rhabdomyolysis
Answer is D. Hypophosphatemia results in decreased synthesis of phosphorylated intermediate metabolites such as adenosine triphosphate (ATP), 2, 3-DPG, and cyclic adenosine monophosphate (cAMP). Deficiency can result in erythrocyte membrane instability, WBC dysfunction, platelet dysfunction, congestive hea failure, arrhythmias, weakening of respiration muscles, hemolysis, and rhabdomyolysis.