Hypophosphatemia in critically ill children

Abstract

The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.

Hypophosphatemia and its clinical implications in critically ill children: A retrospective study

“…Charron et al [21] found that large potassium phosphate boluses were effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains unclear when and how to correct hypophosphatemia in critically ill adults and children [7,22,30]. According to the present study, the authors suggest that 40 to 50 mg/kg daily phosphorous supplementation by enteral route may prevent hypophosphatemia in critically ill children.…”

“…Hypophosphatemia might cause respiratory failure [22]. There was a correlation between the decrease in maximal inspiratory pressure and the severity of hypophosphatemia [23].…”

Calcium, magnesium and phosphorus deficiency in critically ill children

“…Mg deficiency was linked to inborn error of metabolism in our study. 16 De Menezes et al reported 76% of the critical children had hypophosphatemia on admission 6 & 60% in a retrospective Turkish study. 19 Meneses et al found that hypophosphatemia was common in the first 10 days of ICU hospitalization and was associated with the diagnosis of respiratory disease, use of dopamine, and malnutrition.…”

“…5 Potential risk factors for hypophosphatemia reported in the literature, include refeeding, malnutrition, use of diuretics or steroids, catecholamines and antacids, excessive parenteral glucose administration, sepsis, and respiratory alkalosis. 6 The purpose of this investigation was to determine the frequency of hypocalcaemia, hypomagnesaemia and hypophosphataemia with possible risk factors on admission & observe the course of deficiency after 72 h and 10 days.…”

Neck Pain and Rash in an 18-Year-Old Student

“…6 Decreased phosphorous levels are associated with malnutrition, refeeding syndrome, 3 sepsis, trauma, diuretics, and steroid therapy. 7,8 The transaminases aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are sensitive indicators of liver injury and are used to detect diseases such as hepatitis. Alanine aminotransferase is found mainly in the liver, while AST can be found in the liver as well as muscle, organs, and erythrocytes.…”