Phosphate

 Found everywhere in living cells

 Participate in many of the most important
biochemical process
 Examples:
 Genetic materials : DNA and RNA
 Most enzymes and the most important reservoir of biochemical
energy:
 ATP
 CREATINE PHOSPHATE
 PHOSPHENOL PYRUVATE
 Once this phosphate is taken up by the cell, it
remains there to be used in the synthesis of
phosphorylated compounds
 As this phosphorylated compound are metabolized, inorganic
phosphate leaks out of the cell into the blood, where it is
regulated principally by the kidney
 Regulation

 Phosphate in the blood may be absorbed in the

intestine from dietary sources, released from cells
into blood, and lost from bone.
 Disturbances to any of these processes can alter phosphate
concentration in the blood.
• Other factors include:
• Vitamin D- increase phosphate in the blood both phosphate
absorption in the intestine and phosphate reabsorption in the kidney
• Growth Hormone- helps regulate skeletal growth, can affect
circulating concentrations of phosphate
 Distribution

 Concentration of all phosphate compounds in blood

is about 12 mg/dl (3.9 mmol/L)
• 3-4 mg/dl is inorganic, most is organic

 Phosphate is the predominant intracellular anion,

with intracellular concentrations varying, depending
on the type of cell.
 About 80% of the total body pool of phosphate is
contained in the bone, 20% in soft tissues, and less
than 1% is active in serum/plasma
 Clinical Applications

 Hypophosphatemia
 Occurs to 20-40% in patients with the following disorders:
 Diabetic acidosis

 Chronic obstructive pulmonary disease

 Asthma

 Malignancy

 Inflammatory bowel disease

 Anorexia nervosa

 Alcoholism

 In addition, it can also be caused by increased renal absorption as

with vitamin D deficiency
 Hyperphosphatemia
 Greater risk are those with acute or renal failure
 An increased intake of phosphate or increased release of cellular
phosphate may also cause hyperphosphatemia such as cow’s milk
or laxatives
 Increased breakdown of cells can sometimes lead to
hyperphosphatemia as with severe infections, intensive exercise,
neoplastic disorders or intravascular hemolysis
• Because immature lymphoblasts have about 4 times the phosphate
content of mature lymphocytes
 Determination of inorganic phosphorus

 Specimen:
 Serum or Lithium Heparin plasma

 Urine analysis:
 Requires 24-hour sample collection because of significant
diurnal variations
 Methods:
 Involves the formation of an ammonium phosphomolybdate
complex. This colorless complex is measured by ultraviolet
absorption at 340nm or can be reduced to form molybdenum
blue, a stable blue chromophore, which is read between 600
and 700 nm.
 Reference ranges for inorganic phosphorus

 Serum
 Neonate
 1.45-2.91 mmol/L
 Child ≤ 15 years
 1.07-1.74 mmol/L
 Adult
 0.78-1.2 mmol/L
 Urine (24-hr)
 13-42 mmol/day
 Lactate

 The by-product of an emergency mechanism that

produces a small amount of ATP when oxygen
delivery is diminished
 Regulation

 Because lactate is a by product of anaerobic

metabolism, it is not specifically regulated, as with
K⁺ or Ca₂⁺, for example. As oxygen delivery decreases
below a critical level, blood lactate concentrations
rise rapidly and indicate tissue hypoxia earlier than
pH. The liver is the major organ for removing lactate
by converting lactate back to glucose by a process
called “gluconeogenesis”
 Clinical Regulations

 Lactic acidosis
 Type A
 Associated with hypoxic conditions, such as shock, myocardial
infarction, severe congestive heart failure, pulmonary edema, or
severe blood loss
 Type B
 Is of metabolic origin, such as with diabetes mellitus, severe
infection, leukemia, liver or renal disease, and toxins (ethanol,
methanol, or salicylate poisoning)
 Determination of Lactate

 Specimen Handling
 Special care should be practiced when collecting and handling
specimens for lactate analysis.
 Ideally, a tourniquet should not be used because venous stasis
will increase lactate levels. If a tourniquet is used, blood should
be collected immediately and the patient should not exercise
the hand before or during the collection.
 Heparinized blood may be used but must be delivered on ice
and the plasma must be quickly separated
 Iodoacetate or fluoride, which inhibit glycolysis without
affecting coagulation , are usually satisfactory additives
 Methods
 The most commonly used enzymatic method uses lactate
oxidase to produce pyruvate and H₂O₂