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Phosphate is an essential micronutrient involved in numerous critical structural and physiological functions. It is structurally incorporated into the skeletal system (hydroxyapatite), cell membranes (phospholipids) and the cell nucleus (nucleic acids).1,2 Phosphate is central in metabolism, functioning as a key component of adenosine triphosphate and creatinine phosphate. Severe decrease in phosphate levels may, therefore, result in energy depletion.1 Phosphate is also present in 2,3-diphosphoglycerate which is a crucial factor that regulates haemoglobin’s affinity for oxygen.1,2 In the secondary messenger system, phosphate plays a critical role as cyclic adenosine monophosphate and phosphoinositide.1 It is also involved in the regulation of protein function where dephosphorylation or phosphorylation can activate or deactivate different enzymes. Renally it acts as a urinary buffer where it binds with free hydrogen ions.2 Less than one per cent of phosphate is present in plasma and two thirds of this phosphate is in the organic form, as a complex ion, or bound to proteins and lipids. The rest of the plasma phosphate is in the inorganic form (H2PO4, HPO4 and PO4). Intra-cellular shifts of phosphate take place with a glucose or insulin load that result in the intra-cellular phosphorylation of glucose.1

Hypophosphataemia after cardiopulmonary bypass – incidence and clinical significance, a South African perspective