Hypophosphataemia in severe acute malnutrition: a prospective observational study

Abstract

Severe acute malnutrition (SAM) is a major cause of child mortality and morbidity. Children treated for SAM are at risk of refeeding hypophosphataemia (HP). The study was done to find out the incidence and various predictors of moderate/severe HP in SAM among North Indian children. This prospective observational study was conducted from August 2014 to July 2015 in the inpatients’ department of Department of Paediatrics at King George’s Medical University, Lucknow, Uttar Pradesh, North India, a tertiary care teaching hospital. Before inclusion, ethical approval and written informed consent was obtained. Included in the study were sixty-five children aged 6–59 months of age, who were admitted to the hospital with SAM as per the WHO guidelines. SAM was defined as a mid-upper arm circumference <115 mm and/or weight-for-height/length <–3 z-scores of the WHO growth standards and/or have bilateral oedema. Serum P levels were measured on admission and for five consecutive days after starting feed. HP was defined as mild, moderate and severe with a cut-off of 1·19–0·65, 0·65–0·32 and <0·32 mmol/l, respectively. About 60 % children had HP, with 20 % having moderate/severe HP at admission. The proportion of HP increased to 83·1 %, with 38·5 % having moderate/severe HP on day 3 after feeding. It was concluded that HP is a common biochemical abnormality in SAM. Considering its impact on the health of the child, serum P levels should be monitored in patients with SAM who are treated with enteral feeding.

Serum Phosphate Profile of Children With Severe Acute Malnutrition Treated With Locally Prepared Therapeutic Feeds: A Prospective Observational Study

“…Prevalence of hypophosphatemia in our study was 25%, 23.3% and 8.3% on admission, during transition and at discharge, respectively. The prevalence on admission was comparable with studies by Namusoke et al (37%) and Dakshayani et al (17%) [5,8], while Kimutai et al (86%), Hother et al (93%) and Chanchal et al (60%) reported very high prevalence [3,4,7]. Higher prevalence in the study by Kimutai et al could be explained by difference in study population as they enrolled only children with edematous malnutrition.…”

“…Other studies reported mean serum phosphate levels lesser than 4 mg/dL on admission and transition. Also, the level usually fell from admission for first few days, as starter diet contains limited phosphate before it rises once catch-up diet with more phosphate is introduced [3,7]. Mean serum phosphate at discharge was comparable to studies done by Namusoke et al [5], but overall mean increase of 0.75 mg/dL in our study was less than 2.07 mg/dL reported by Namusoke et al…”

“…Treatment with diets high in carbohydrate but with inadequate amount of phosphorus, magnesium, potassium and thiamine can result in refeeding syndrome which is characterized by hypophosphatemia, hypomagnesemia, hypokalemia and other abnormalities. On reviewing the literature, several studies reported varying prevalence of hypophosphatemia ranging from 17% to 93% [3][4][5][6][7][8][9]. Most of commercial premix (F-75) has added extrinsic phosphorus to meet United Nations procurement specifications of more than 60 mg/100 mL.…”

Impact of serum phosphate changes on in-hospital mortality

“…Serum phosphate levels have been identified as strong predictors on clinical outcomes, including hospital mortality [4]. While hypophosphatemia is shown to be independently associated with increased mortality among critically ill patients, malnourished individuals, and patients with sepsis [5][6][7], hyperphosphatemia is associated with poor clinical outcomes including mortality in chronic kidney disease (CKD) [8,9], hemodialysis [10,11], acute coronary syndrome [12], and general patient population [13][14][15][16][17][18][19].…”

“…While previous studies have focused on the impact of serum phosphate disorders (hypophosphatemia and hyperphosphatemia) [5][6][7][13][14][15][16][17], knowledge about the significance of changes in serum phosphate level and allcause mortality remains scarce. Among patients on maintenance hemodialysis, a recent study demonstrated that high variability of serum phosphate was independently correlated with increased all-cause and cardiovascular mortality, while stable serum phosphate levels and low serum phosphate variability were associated with reduced patient mortality [10].…”