Elsewhere in this issue (see p 673), Ryback and his associates confirm the common occurrence1 of hypophosphatemia in hospitalized alcoholics. It is important to recognize this finding since either hypophosphatemia or phosphorus deficiency may play an important role in the morbidity of the long-term alcoholic. The ubiquitous, poorly nourished alcoholic often shows a telltale pattern of electrolyte and acid base disturbances.2 However, these include not only hypophosphatemia but also hypomagnesemia, hypocalcemia, hypokalemia, and respiratory alkalosis. In addition, these patients commonly show a remarkably low BUN concentration.
The incidence of hypophosphatemia in alcoholics depends on the diligence with which one looks for it. Serum phosphorus level may be normal when patients are first admitted to the hospital but subsequently decline. Thus, it is often necessary to measure serum phosphorus levels on several consecutive days. This pattern of hypophosphatemia in alcoholics resembles that seen in diabetic ketoacidosis after administration of