Refeeding hypophosphatemia: a potentially fatal danger in the intensive care unit

To determine the overall and comparative incidence of refeeding hypophosphatemia (RH) between enteral and parenteral nutrition in general adult intensive care unit (ICU) patients. Materials and methods: This study was performed as a retrospective analysis. A total of 117 patients who received enteral and parenteral nutrition were included in the study. Demographic characteristics, type of nutrition, daily energy intake, and serum phosphorus levels before and after the initiation of the nutrition were recorded for 7 days. Results: The mean age of the patients was 65.8 ± 16.7 years. RH was found in 61 patients (52.14%). There was no significant difference in RH with regard to nutrition type (P = 0.756). The duration of the ICU stay was longer in the patients with RH compared with the patients without RH [median: 12 (3-68) and 8.5 (3-41) days, respectively; P = 0.025]. The mortality rate was higher in patients with RH compared with patients without RH (P = 0.037). Conclusion: The incidence of RH was quite high in our medical ICU. The mortality rate and the duration of ICU stay were higher in the patients with RH than those without RH.

Refeeding hypophosphatemia: a potentially fatal danger in the intensive care unit

To determine the overall and comparative incidence of refeeding hypophosphatemia (RH) between enteral and parenteral nutrition in general adult intensive care unit (ICU) patients. Materials and methods: This study was performed as a retrospective analysis. A total of 117 patients who received enteral and parenteral nutrition were included in the study. Demographic characteristics, type of nutrition, daily energy intake, and serum phosphorus levels before and after the initiation of the nutrition were recorded for 7 days. Results: The mean age of the patients was 65.8 ± 16.7 years. RH was found in 61 patients (52.14%). There was no significant difference in RH with regard to nutrition type (P = 0.756). The duration of the ICU stay was longer in the patients with RH compared with the patients without RH [median: 12 (3-68) and 8.5 (3-41) days, respectively; P = 0.025]. The mortality rate was higher in patients with RH compared with patients without RH (P = 0.037). Conclusion: The incidence of RH was quite high in our medical ICU. The mortality rate and the duration of ICU stay were higher in the patients with RH than those without RH.

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  • Weisinger JR, Bellorin-Font E. Magnesium and phosphorus. Lancet 1998; 352: 391–396.
  • Shor R,  Halabe A,  Rishver S,  Tilis Y,  Matas Z,  Fux A,  Boaz M,  Weinstein J. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci 2006; 36: 67–72.
  • Fu JH, Zang B. The occurrence of hypophosphatemia and its prognostic value in intensive care unit patients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2012; 24: 29–32.
  • Hoffmann M, Zemlin AE, Meyer WP, Erasmus RT. Hypophosphataemia at a large academic hospital in South Africa. J Clin Pathol 2008; 61: 1104–1107.
  • Vignaud M, Constantin JM, Ruivard M, Villemeyre-Plane M, Futier E, Bazin JE, Annane D; AZUREA group (AnorexieRea Study Group). Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study. Crit Care 2010; 14: R172.
  • Patel U, Sriram K. Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition. Nutrition 2009; 25: 364–367.
  • Miller DW, Slovis CM. Hypophosphatemia in the emergency department therapeutics. Am J Emerg Med Jul 2000; 18: 457– 4
  • 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: R147.
  • Schnitker M, Mattman P, Bliss T. A clinical study of malnutrition in Japanese prisoners of war. Ann Intern Med 1951; 35: 69–96.
  • Marinella MA. Refeeding syndrome: an important aspect of supportive oncology. J Support Oncol 2009; 7: 11–16.
  • Stanga Z, Brunner A, Leuenberger M, Grimble RF, Shenkin A, Allison SP, Lobo DN. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr 2008; 62: 687–694.
  • Tresley J, Sheean PM. Refeeding syndrome: recognition is the key to prevention and management. J Am Diet Assoc 2008; 108: 2105–2108.
  • Hoffer LJ. Metabolic consequences of starvation. In: Shils M, Olson JA, Shike M, Ross AC, editors. Modern Nutrition in Health and Disease. 10th ed. Baltimore, MD, USA: Lippincott Williams and Wilkins; 2006. pp. 741–748.
  • Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition 2001; 17: 632–637.
  • Marinella MA. Refeeding syndrome and hypophosphatemia. J Intensive Care Med 2005; 20: 155–159.
  • Whyte E, Jefferson P, Ball DR. Anorexia nervosa and the refeeding syndrome. Anaesthesia 2003; 58: 1025–1026.
  • Zeki S, Culkin A, Gabe SM, Nightingale JM. Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients. Clin Nutr 2011; 30: 365–368.
  • Marik PE, Bedigian MK. Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch Surg 1996; 131: 1043–1047.
  • Kraft MD, Btaiche IF, Sacks GS. Review of the refeeding syndrome. Nutr Clin Pract 2005; 20: 625–633.
  • Murciano D, Rigaud D, Pingleton S, Armengaud MH, Melchior JC, Aubier M. Diaphragmatic function in severely malnourished patients with anorexia nervosa. Effects of renutrition. Am J Respir Crit Care Med. 1994; 150: 1569–1574.
  • Aubier M,  Murciano D,  Lecocguic Y, Viires N, Jacquens Y, Squara P, Pariente R. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med 1985; 313: 420–424.
  • Meral M, Araz Ö, Yılmazel Uçar E, Yılmaz N, Mirici NA. Nutritional assessment via anthropometric and biochemical measurements with stable COPD. Turk J Med Sci 2012; 42: 1490–1493.
  • Demirjian S, Teo BW, Guzman JA, Heyka RJ, Paganini EP, Fissell WH, Schold JD, Schreiber MJ. Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant 2011; 26: 3508–3514.
  • Davis SV, Olichwier KK, Chakko SC. Reversible depression of myocardial performance in hypophosphatemia. Am J Med Sci 1988; 295: 183–187.
  • Zazzo JF, Troché G, Ruel P, Maintenant J. High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Intensive Care Med 1995; 21: 826–831.
  • Silvis SE, Paragas PD Jr. Paresthesias, weakness, seizures, and hypophosphatemia in patients receiving hyperalimentation. Gastroenterology 1972; 62: 513–520.
  • Santana e Meneses JF, Leite HP, de Carvalho WB, Lopes E Jr. Hypophosphatemia in critically ill children: prevalence and associated risk factors. Pediatr Crit Care Med 2009; 10: 234– 2
  • Benjamin J, Singh N, Makharia GK. Enteral nutrition for severe malnutrition in chronic intestinal pseudo-obstruction. Nutrition 2010; 26: 502–505.
  • Mclntyre N, Holdsworth C,Turner D. New interpretatıon of oral glucose tolerance. Lancet 1964; 2: 20–21.
  • Lubart E, Leibovitz A, Dror Y, Katz E, Segal R. Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia the contribution of refeeding syndrome. Gerontology 2009; 55: 393–397.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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Refeeding hypophosphatemia: a potentially fatal danger in the intensive care unit*

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