Hypophosphatemia in Enterally Fed Patients in the Surgical Intensive Care Unit

Fuentes, Eva; Yeh, D. Dante; Quraishi, Sadeq A.; Johnson, Emily; Kaafarani, Haytham M.A.; Lee, Jarone; King, David R.; DeMoya, Marc; Fagenholz, Peter J.; Butler, Kathryn L.; Chang, Yuchiao; Velmahos, George C.

doi:10.1177/0884533616662988

Cited by 47 publications

(39 citation statements)

References 18 publications

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“…The difficulty in RFS diagnosing is due to the discrepancy between the onset of the symptoms and the occurring of metabolic shift (see below), and the nonspecific nature of its clinical manifestations [46]. There is a great heterogeneity among the published definitions of RFS, ranging from hypophosphatemia alone [18,19,22,24,27,[49][50][51][52][53][54] to the presence of severe low-serum electrolyte levels along with fluid balance abnormalities and/or organ dysfunction [16,21,34,55]. Only hypophosphatemia has been universally recognized as a feature of the syndrome [38].…”

Section: Diagnosis Of Rfsmentioning

confidence: 99%

“…Since then, many cases of RFS have been described as a rare, but severe and potentially fatal complication related to re-feeding (either orally, enterally or parenterally) of individuals who have fasted or consumed very few calories over a long period of time [10,11]. Among the diseases or conditions predisposing to malnutrition and consequently to RFS after re-feeding, anorexia nervosa [12][13][14], cancer [15,16], critical illnesses [13,[17][18][19][20], and frailty in the elderly [21][22][23][24][25][26][27] are the most frequently implicated.…”

Section: Introductionmentioning

confidence: 99%

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The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2–5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.

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Section: Diagnosis Of Rfsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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“…Phosphate homeostasis is complex, and the phosphate ion may be influenced by other factors, such as decreased renal clearance, increased consumption in catabolic patients, intestinal losses, or clearance over a continuous renal replacement therapy (CRRT) membrane. Importantly, hypophosphatemia is among the most frequently encountered electrolyte metabolic disturbances in critically ill patients with an incidence and prevalence ranging within 2.4–100% [13, 14]. Unlike other electrolyte disturbances, negligible importance has been given to the derangement of phosphate homeostasis during management of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study

et al. 2019

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Background Hypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored. The aim of this study was to investigate whether hypophosphatemia can be a risk factor for ICU 28-day mortality. Methods A single-center retrospective cohort study was conducted by collecting data from 1073 patients admitted to general ICU and then presented to the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou City, Guangdong Province, China) from 1 January 2016 to 31 December 2017. The patients were divided into a normal control group (serum phosphate levels 0.80–1.60 mmol/L) and a hypophosphatemia group (serum phosphate levels < 0.80 mmol/L), based on the concentration of phosphorus at the time of ICU admission. The association between phosphate levels and ICU 28-day mortality was evaluated by binary logistic regression analysis. Multivariate logistic regression was employed to predict the ICU 28-day mortality. Results The cohort included 946 patients with a median phosphate concentration of 0.77 mmol/L (interquartile range 0.55–1.03 mmol/L). Patients with hypophosphatemia had a higher ICU 28-day mortality than the normal control group (33.3% vs 24.0%, P < 0.05). Patients with hypophosphatemia had a longer ICU and hospital stays, and prolonged duration of mechanical ventilation (all P < 0.05). Hypophosphatemia was an independent risk factor for ICU 28-day mortality (adjusted OR = 1.5, 95% CI = 1.1–2.1, P = 0.01) in the multivariate logistic regression analysis. Conclusions Hypophosphatemia at admission is an independent risk factor for 28-day mortality in general ICU patients. Trial registration The medical study was approved by the Institutional Ethics Committee of the Six Affiliated Hospital, Sun Yat-sen University (Approval number: 2017ZSLYEC-110). No consent was given as the data were analyzed anonymously.

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“…Общепринятым маркером РФС является гипофосфатемия, встречающаяся у 1-3 % госпитализированных пациентов, а у некоторых категорий пациентов превышающая 20 % [9]. У пациентов ОРИТ частота гипофосфатемии, по разным данным, составляет 34-59 % [5,7]. Такая разница в показателях связана с тем, что практически в каждой работе принимали разный диагностический порог гипофосфатемии от < 0,32 до < 1 ммоль/л [5,6,10].…”

Section: эпидемиологияunclassified

“…РФС исторически считали проблемой пациентов с нервной анорексией и длительным голоданием, пока не обратили внимание на то, что у некоторых групп пациентов частота гипофосфатемии после возобновления питания составляет 20 %, а у пациентов отделения реанимации и интенсивной терапии (ОРИТ) может достигать 59 % [5]. В последние годы началось изучение эпидемиологии РФС у пациентов ОРИТ, а также наметилась стратегия для оптимизации диагностики и лечения синдрома возобновления питания у пациентов в критических состояниях [6,7].…”

Section: Introductionunclassified

Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

Yaroshetskiy

Konanykhin

Stepanova³

et al. 2019

Annals of Critical Care

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Refeeding syndrome is a life-threatening condition that occurs when nutrition is restarted in patients with initial malnutrition. For the first time refeeding syndrome was described more than 70 years ago but it still has not been studied enough. The pathophysiology of refeeding syndrome is based on severe electrolyte and metabolic disorders caused by the restoration of nutrition with an initial deficiency of phosphorus, potassium, magnesium which lead to organ failure. Hypophosphatemia is the main feature of the refeeding syndrome while in ICU patients there are many other causes of hypophosphatemia which complicates diagnostics. Most studies on refeeding syndrome have been conducted among patients with anorexia nervosa. In ICU refeeding hypophosphatemia occurs in about 34 % of cases but until recently all guidelines for the management of this condition have been extrapolated from the practice of treatment anorexia nervosa and were based on expert opinion. Several major studies have proven the effectiveness of a hypocaloric feeding during refeeding syndrome in critically ill patients recently. This review is devoted to the problem of refeeding syndrome in patients with anorexia nervosa and critical care patients, differential diagnostics and treatment approaches for this condition.

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Hypophosphatemia in Enterally Fed Patients in the Surgical Intensive Care Unit

Abstract: RH is common in the SICU but is not related to timing or amount of EN. Hypophosphatemia is also common in the critically ill, but regardless of etiology, it was not found to be a predictor of worse clinical outcomes.

Cited by 47 publications

References 18 publications

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study

Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

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