Paresthesias, Weakness, Seizures, and Hypophosphatemia in Patients Receiving Hyperalimentation

Huntington Disease – Principles and practice of nutritional management

“…Cells absorb and use more potassium, magnesium, phosphate, and water follows by osmosis. Finally deficiency of serum phosphate, potassium, magnesium, and thiamine may lead to the clinical features of RS, including rhabdomyolysis, leukocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death [39,40].…”

Hyponatremia and other electrolyte/ion disorders

“…Hypophosphatemia has been implicated in the development of several complications: myopathy, congestive cardiomyopathy, respiratory failure, neurologic dysfunction, and hemolysis [94][95][96][97][98]. To detect hyposphosphatemia in the alcoholic patient with or without liver disease, serum phosphate levels should be evaluated at the time of admission and then every 24 hours for the first 3-5 days, because the early phase of alcoholic withdrawal is associated with a high rate of respiratory alkalosis which is one of the causes of hypophosphatemia.…”

Serotonergic and tryptaminergic overstimulation on refeeding implicated in “enlightenment” experiences

“…American troops on feeding starving concentration camp prisoners reported similar experiences and had to switch to a low calorie refeeding regimen for these prisoners [32]. Clinical features of refeeding syndrome include delirium and cardiac failure, respiratory failure, rhabdomyolysis, leucocyte dysfunction, hypotension, arrhythmias, seizures, coma, and sudden death [33][34][35]. Table 1 Estimated changes in human plasma tryptophan (TRP) and large, neutral amino acids (LNAA) after consuming 2 g TRP with different midday meals [27].…”

“…This stimulates cellular uptake of phosphate due to the action of the enzyme phosphofructokinase that attaches phosphate to glucose in order to metabolize it. This causes a high, temporary demand for phosphate from the blood and the reduced levels of phosphate in the blood can cause a fatal cardiac arrest, a result of cardiac dysrhythmia [34]. Consequently, it appears to be largely a matter of good fortune that Gautama's first meal consisted of milk and rice, both of which have high natural phosphate content [25].…”