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Review article: Biomedical intelligence

Vol. 155 No. 5 (2025)

Effects of chronic alcohol use disorder and alcohol withdrawal on phosphate, magnesium, and calcium

Cite this as:
Swiss Med Wkly. 2025;155:4072
Published
27.05.2025

Summary

In addition to frequent hyponatraemia, excessive and chronic alcohol consumption can lead to disturbances in phosphorus, magnesium and calcium balance.

Due to the close physiological interactions between phosphorus, magnesium and calcium, changes in one or more of these substances can lead to a life-threatening vicious cycle.

Electrolyte imbalances are common during alcohol withdrawal and require careful monitoring and treatment.

References

  1. Kuendig H. Estimation du nombre de personnes alcoolo-dépendantes dans la population helvétique (Rapport de recherce No 56). Lausanne: Addiction Info Suisse; 2010., Available from https://www.suchtmonitoring.ch/docs/library/kuendig_herve_ii2ajqwt12iq.pdf
  2. Schweizerische Eidgenossenschaft - Bundesamt für Statistik. Medizinische Statistik der Krankenhäuser: Anzahl Fälle und durchschnittliche Aufenthaltsdauer (DAD) nach Altersklasse und Diagnosekode. Dezember 2024. Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/kataloge-datenbanken.assetdetail.33787452.html
  3. Wagner J, Hernandez-Blanco Y, Yu A, Garcia-Rodriguez V, Mohajir W, Goodman C, et al. Hypophosphatemia Is More Common and Is Prognostic of Poorer Outcomes in Severe Alcoholic Pancreatitis. Pancreas. 2021 Nov-Dec;50(10):1440–4. doi: https://doi.org/10.1097/MPA.0000000000001952
  4. De Marchi S, Cecchin E, Basile A, Bertotti A, Nardini R, Bartoli E. Renal tubular dysfunction in chronic alcohol abuse—effects of abstinence. N Engl J Med. 1993 Dec;329(26):1927–34. 10.1056/NEJM199312233292605
  5. Curthoys NP, Moe OW. Proximal tubule function and response to acidosis. Clin J Am Soc Nephrol. 2014 Sep;9(9):1627–38. 10.2215/CJN.10391012
  6. Ginn HE, Shanbour LL. Phosphaturia in magnesium-deficient rats. Am J Physiol. 1967 Jun;212(6):1347–50. 10.1152/ajplegacy.1967.212.6.1347
  7. Hidaka N, Kato H, Koga M, Katsura M, Oyama Y, Kinoshita Y, et al. Induction of FGF23-related hypophosphatemic osteomalacia by alcohol consumption. Bone Rep. 2021 Oct;15:101144. 10.1016/j.bonr.2021.101144
  8. Laitinen K, Lamberg-Allardt C, Tunninen R, Karonen SL, Tähtelä R, Ylikahri R, et al. Transient hypoparathyroidism during acute alcohol intoxication. N Engl J Med. 1991 Mar;324(11):721–7. 10.1056/NEJM199103143241103
  9. Na D, Tao G, Shu-Ying L, Qin-Yi W, Xiao-Li Q, Yong-Fang L, et al. Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study. BMC Endocr Disord. 2021 Aug;21(1):170. 10.1186/s12902-021-00838-y
  10. Robertson GM Jr, Moore EW, Switz DM, Sizemore GW, Estep HL. Inadequate parathyroid response in acute pancreatitis. N Engl J Med. 1976 Mar;294(10):512–6. 10.1056/NEJM197603042941002
  11. Ryzen E, Rude RK. Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia. West J Med. 1990 Feb;152(2):145–8.
  12. Rude RK, Oldham SB, Singer FR. Functional hypoparathyroidism and parathyroid hormone end-organ resistance in human magnesium deficiency. Clin Endocrinol (Oxf). 1976 May;5(3):209–24. 10.1111/j.1365-2265.1976.tb01947.x
  13. Laitinen K, Tähtelä R, Välimäki M. The dose-dependency of alcohol-induced hypoparathyroidism, hypercalciuria, and hypermagnesuria. Bone Miner. 1992 Oct;19(1):75–83. 10.1016/0169-6009(92)90845-5
  14. Baj J, Flieger W, Teresiński G, Buszewicz G, Sitarz R, Forma A, et al. Magnesium, Calcium, Potassium, Sodium, Phosphorus, Selenium, Zinc, and Chromium Levels in Alcohol Use Disorder: A Review. J Clin Med. 2020 Jun;9(6):1901. doi: https://doi.org/10.3390/jcm9061901
  15. Shkurashivska S, Ersteniuk H. The Effect of Adrenaline on the Mineral and Trace Element Status in Rats. Open Life Sci. 2019 May;14(1):158–64. 10.1515/biol-2019-0018
  16. Lombardi G, Ziemann E, Banfi G, Corbetta S. Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism. Int J Mol Sci. 2020 Jul;21(15):5388. 10.3390/ijms21155388
  17. Kenny CM, Murphy CE, Boyce DS, Ashley DM, Jahanmir J. Things We Do for No Reason™: Calculating a “Corrected Calcium” Level. J Hosp Med. 2021 Aug;16(8):499–501. 10.12788/jhm.3619
  18. Palmer BF, Clegg DJ. Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorder. N Engl J Med. 2017 Oct;377(14):1368–77. 10.1056/NEJMra1704724
  19. Ayhan YE, İlerler EE, Sosyal D, Bektay MY, Karakurt S, Daşkaya H, et al. Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study. Front Med (Lausanne). 2024 Jun;11:1343483. 10.3389/fmed.2024.1343483
  20. Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care. 2010;14(4):R147. 10.1186/cc9215
  21. Vanoni FO, Milani GP, Agostoni C, Treglia G, Faré PB, Camozzi P, et al. Magnesium Metabolism in Chronic Alcohol-Use Disorder: Meta-Analysis and Systematic Review. Nutrients. 2021 Jun;13(6):1959. 10.3390/nu13061959
  22. Carnevale V, Nieddu L, Scillitani A, Tinti MG, Eller-Vainicher C, Cosso R, et al. Calcium-phosphate homeostasis and insulin resistance in men. Nutr Metab Cardiovasc Dis. 2024 Feb;34(2):353–9. 10.1016/j.numecd.2023.08.020
  23. Gommers LM, Hoenderop JG, Bindels RJ, de Baaij JH. Hypomagnesemia in Type 2 Diabetes: A Vicious Circle? Diabetes. 2016 Jan;65(1):3–13. 10.2337/db15-1028
  24. Liamis G, Liberopoulos E, Barkas F, Elisaf M. Diabetes mellitus and electrolyte disorders. World J Clin Cases. 2014 Oct;2(10):488–96. 10.12998/wjcc.v2.i10.488
  25. Palmer BF, Clegg DJ. Kidney-Protective Effects of SGLT2 Inhibitors. Clin J Am Soc Nephrol. 2023 Feb;18(2):279–89. 10.2215/CJN.09380822
  26. Tang H, Zhang X, Zhang J, Li Y, Del Gobbo LC, Zhai S, et al. Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials. Diabetologia. 2016 Dec;59(12):2546–51. 10.1007/s00125-016-4101-6
  27. Llorente C, Jepsen P, Inamine T, Wang L, Bluemel S, Wang HJ, et al. Gastric acid suppression promotes alcoholic liver disease by inducing overgrowth of intestinal Enterococcus. Nat Commun. 2017 Oct;8(1):837. 10.1038/s41467-017-00796-x
  28. Kieboom BC, Kiefte-de Jong JC, Eijgelsheim M, Franco OH, Kuipers EJ, Hofman A, et al. Proton pump inhibitors and hypomagnesemia in the general population: a population-based cohort study. Am J Kidney Dis. 2015 Nov;66(5):775–82. 10.1053/j.ajkd.2015.05.012
  29. Adomako EA, Yu AS. Magnesium Disorders: core Curriculum 2024. Am J Kidney Dis. 2024 Jun;83(6):803–15. 10.1053/j.ajkd.2023.10.017
  30. Rosner MH, Ha N, Palmer BF, Perazella MA. Acquired Disorders of Hypomagnesemia. Mayo Clin Proc. 2023 Apr;98(4):581–96. 10.1016/j.mayocp.2022.12.002