Life-threatening hypophosphataemia in a cirrhotic patient with jaundice

We report the case of a 51-year-old patient with a history of liver cirrhosis, who presented with jaundice (total bilirubin 50 mg/dl [855 mu mol/1], direct bilirubin 20 mg/dl [342 mu mol/1]) and life-threatening hypophosphataemia (serum phosphate 0.5 mg/dl [0.16 mmol/1]), accompanied by inappropriate phosphaturia. The patient also manifested hypouricaemia (serum uric acid 1.7 mg/dl [101 mu mol/1]) with renal uric acid wasting and renal glycosuria. This generalized proximal tubular defect may occasionally be seen in deeply jaundiced patients. Therefore, serum phosphate levels should be closely monitored in these patients.