Reduced red cell glycolysis, 2,3-diphosphoglycerate and adenosine triphosphate concentration and increased haemoglobin oxygen affinity caused by hypophosphatemia

A marked reduction in red cell glucose utilization, lactate production, and 2,3-diphosphoglycerate and adenosine triphosphate concentration occurred in a patient with intractable diarrhea during a period of hypophosphatemia induced by parenteral nutrition with hypertonic glucose and protein hydrolysate. During the period of hypophosphatemia the patient's hemoglobin had an increased affinity for oxygen. Restoration of plasma phosphate to normal in vivo or in vitro corrected the metabolic abnormalities of the patient's erythrocytes. During normophosphatemia hemoglobin-oxygen affinity was decreased in keeping with the increase in red cell organic phosphates associated with anemia. Therefore, severe hypophosphatemia in man can produce significan