Hypophosphataemia and parenteral nutrition; biochemical monitoring, incidence and outcomes

Fung, En C.; Wickramasinghe, Sasala R.; Panteli, J.; Crook, Martin

doi:10.1080/09674845.2016.1209896

Cited by 7 publications

(16 citation statements)

References 18 publications

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“…Mortality rate was also higher in patients with RS (83.3%) than in those without this condition (66.7%). 10 By contrast, a retrospective study 14 carried out with 57 patients admitted to the ICU and other settings, in a hospital in London, receiving PN identified refeeding hypophosphatemia in 40.4% of patients, with no difference in its incidence between survivors and no survivors.…”

Section: Discussionmentioning

confidence: 95%

Refeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study

et al. 2020

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Background Refeeding syndrome (RS) is characterized by severe electrolyte derangement that may be associated with worse clinical outcomes in hospitalized patients. In this study, we aim to assess the incidence of RS in inpatients receiving parenteral nutrition (PN) and its possible association with the length of hospital stay (LHS) and mortality. Methods We conducted a historical cohort study involving adults receiving PN, monitored by a nutrition therapy team in a Brazilian public hospital. Data collection was made from electronic records. We assessed the presence of RS after PN therapy was initiated. The amount of energy delivered within 72 hours of PN, LHS, and mortality were compared between patients with and without RS. Results One‐hundred ninety‐seven patients (aged 57.7 ± 14.1 years; 55.7% men) were followed for a median of 51 days. The incidence of RS was equal to 25.4%. The adequacy of energy delivered in relation to energy requirements within 72 hours (69.4% ± 29.3% vs 61.8% ± 21.6%) was higher in patients with RS than in those without RS (P = .054). The incidence of death was 55.3% and did not differ between groups. The median of LHS was equal to 51.0 (32.0–83.0) days, and it also did not differ between patients with and without RS. Conclusion RS was identified in 25% of patients receiving PN, but it was not associated to mortality and LHS, even when energy delivery was considered in combination to RS.

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Section: Discussionmentioning

confidence: 95%

Refeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study

et al. 2020

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“…9,10 The rarity of HPr and severe HP cases observed in our study may be related to our exclusion of patients receiving PN, in whom such complications are known to commonly occur. 9 We believe that frequent monitoring of serum phosphorus levels and prompt replacement may help detect mild HP and prevent severe HP.…”

Section: Resultsmentioning

confidence: 80%

“…Previous studies with critically ill pediatric patients show an even higher incidence of HP (42.0%–79.5%) 1,2,11–14 . This difference may have occurred because, in general, most studies did not exclude patients receiving PN, and this nutrition route is known to be related to a decrease in serum phosphorus levels in children and adult patients 9,10 …”

Section: Discussionmentioning

confidence: 99%

“…The incidence of HP in severely ill children receiving EN and/or oral nutrition is poorly studied. P disturbances are commonly related to the infusion of parenteral nutrition (PN) in children and adults 9,10 . Studies on general PICU populations, including those receiving PN, have reported HP rates of ∼40%–60% 1,11–14 .…”

Section: Introductionmentioning

confidence: 99%

“…P disturbances are commonly related to the infusion of parenteral nutrition (PN) in children and adults. 9,10 Studies on general PICU populations, including those receiving PN, have reported HP rates of ∼40%-60%. 1,[11][12][13][14] In patients with burn injuries, the rates were observed to be as high as ∼80%.…”

Section: Introductionmentioning

confidence: 99%

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Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

Springer

Hortêncio

Melro

et al. 2021

J Parenter Enteral Nutr

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Background: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake. Methods:A prospective, observational cohort study was conducted in a PICU of a quaternary hospital. Participants aged between 28 days and 14 years were included.Anthropometric and laboratory assessments were performed ≤72 h after PICU admission and repeated after 7 days for three consecutive times. Energy, protein, calcium, phosphate, and vitamin D intake per day of hospitalization were recorded individually.The Pediatric Index of Mortality 2 (PIM2) was used to determine each patient's severity score.Results: A total of 103 participants were included in the study. Hypophosphatemic events ranged from 27.2% to 37.5% among the assessments. HP was associated with high C-reactive protein levels (P = .012) and lower energy adequacy (P = .037). Serum phosphorus was inversely correlated (weak correlation) with PIM2 (P = .017). Conclusion:HP is common in critically ill pediatric patients, even when they are not receiving parenteral nutrition. It is necessary to monitor serum phosphorus levels and consider the possibility of early replacement, especially in patients showing high levels of inflammation. In addition to inflammation itself, low energy intake and illness severity were related to HP.

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Association between energy delivery from parenteral nutrition and refeeding syndrome in hospitalized adults: A retrospective cohort study

Apiromruck,

Kano,

Taemkaew

et al. 2024

J Parenter Enteral Nutr

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BackgroundPatients receiving parenteral nutrition (PN) may develop refeeding syndrome (RFS). This study determined RFS prevalence in hospitalized adults on PN and evaluated whether higher energy delivered by PN on day 1 of PN initiation was associated with RFS development.MethodsWe reviewed the medical records of adult patients receiving PN at a Thai quaternary hospital from June 2019 to May 2022. RFS was defined based on the Nutrition Management Clinical Practice Recommendation by the Society of Parenteral and Enteral Nutrition of Thailand. The association between PN energy delivery and RFS development was determined using a generalized estimating equation for multiple logistic regression analysis adjusted for NICE guideline risk factors.ResultsA total of 547 patients was included (mean age 59.8 ± 17.2 years, mean body mass index 20.7 ± 4.8 ). The prevalence of RFS was 45%. Factors associated with RFS included energy from PN on the first day of PN initiation (adjusted odds ratio [aOR] 1.17; 95% CI 1.04–1.33; for every 5 kcal/kg/day increase), starvation >5 days prior to PN (aOR 1.54; 95% CI 1.04–2.26), concomitant diuretic use (aOR 1.81; 95% CI 1.25–2.64), low baseline potassium level (aOR 1.79; 95% CI 1.19–2.70), and individual compounding PN (aOR 1.61; 95% CI 1.04–2.51).ConclusionRFS was common among hospitalized patients receiving PN. The amount of energy delivered on the first day of PN was independently associated with RFS, raising a concern regarding initiation of PN with higher energy.

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Hypophosphataemia and parenteral nutrition; biochemical monitoring, incidence and outcomes

Cited by 7 publications

References 18 publications

Refeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study

Refeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

Association between energy delivery from parenteral nutrition and refeeding syndrome in hospitalized adults: A retrospective cohort study

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