Prevalence Of Hypophosphatemia Research Articles

Prevalence, predictors and natural history of hypophosphatemia following iron infusion

Abstract Iron deficiency is the leading cause of anemia, which affects one quarter of the adult population globally. Intravenous iron is a well-established treatment option and is generally well tolerated. However, there is increasing recognition that it can cause hypophosphatemia, which can result in fatigue, nausea, myalgia, weakness and osteomalacia. We sought to determine the prevalence, natural history and predictors of hypophosphatemia following iron infusion in a tertiary hospital. All adult patients who received one or more iron infusions between January 1st 2019 to December 31st 2021 were included in this retrospective study. 2367 subjects were identified, receiving a total of 7063 infusions over the study period. Hypophosphatemia was defined as a serum phosphate level of <0.75 mmol/L (<2.32 mg/dL), with severity classified as mild 0.65-0.75 mmol/L (2.01-2.31 mg/dL), moderate 0.32-0.64 mmol/L (0.99-1.98 mg/dL), or severe <0.32 mmol/L (<0.99 mg/dL). Prevalence of hypophosphatemia was 48.9%, with the highest prevalence from day 4 to 20 post-iron infusion (39.3-44.1%). Risk factors were receipt of iron polymaltose (OR 2.33, CI 1.71-3.19, P<.0001), receipt of ferric carboxymaltose (OR 1.79, CI 1.29-2.48, P=.001), male gender (OR 1.35, CI 1.09-1.66, P=.006) and multiple iron infusions (OR 1.56, CI 1.20-2.03, P=.001). Risk was reduced in recipients with higher baseline phosphate (OR 0.18, CI 0.11-0.28, P<.0001), higher baseline creatinine (OR 0.83, CI 0.74-0.92, P=.001) and increased weight (OR 0.99, CI 0.99-1.00, P=.016). Risk factors for moderate to severe hypophosphatemia were the same, except that gender became non-significant, while increasing age (OR 0.99, CI 0.99-1.00, P=.002) was also associated with reduced risk. These findings may aid clinicians in identifying those at greatest risk of developing significant hypophosphatemia, thereby preventing adverse outcomes.

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

BackgroundData is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the prevalence of admission phosphate abnormality and the association between serum phosphate level and length of hospital stay and all-cause mortality in adult patients.MethodsThis was a multi-center retrospective study based on real-world data. Participants were classified into five groups according to serum phosphate level (inorganic phosphorus, iP) within 48 h after admission: G1, iP < 0.64 mmol/L; G2, iP 0.64–0.8 mmol/L; G3, iP 0.8–1.16 mmol/L; G4, iP 1.16–1.45 mmol/L; and G5, iP ≥ 1.45 mmol/L, respectively. Both LOS and in-hospital mortality were considered as outcomes. Clinical information, including age, sex, primary diagnosis, co-morbidity, and phosphate-metabolism related parameters, were also abstracted from medical records.ResultsA total number of 23,479 adult patients (14,073 males and 9,406 females, aged 57.7 ± 16.8 y) were included in the study. The prevalence of hypophosphatemia was 4.74%. An “L-shaped” non-linear association was determined between serum phosphate level and LOS and the inflection point was 1.16 mmol/L in serum phosphate level. Compared with patients in G4, patients in G1, G2 or G3 were significantly associated with longer LOS after full adjustment of covariates. Each 0.1 mmol/L decrease in serum phosphate level to the left side of the inflection point led to 0.64 days increase in LOS [95% confidence interval (CI): 0.46, 0.81; p for trend < 0.001]. But there was no association between serum phosphate and LOS where serum levels of phosphate ≥ 1.16 mmol/L. Multivariable logistic regression analysis showed that adjusted all-cause in-hospital mortality was 3.08-fold greater in patients in G1 than those in G4 (95% CI: 1.52, 6.25; p for trend = 0.001). Similarly, no significant association with either LOS or mortality were found in patients in G5, comparing with G4.ConclusionsHypophosphatemia, but not hyperphosphatemia, was associated with LOS and all-cause mortality in adult inpatients. It is meaningful to monitor serum levels of phosphate to facilitate early diagnosis and intervention.

Prevalence of hypophosphatemia in children with diabetic ketoacidosis and treatment with subcutaneous regular insulin. Observational study

To estimate the incidence of hypophosphatemia in children with DKA, treated with subcutaneous regular insulin (IRS), and to explore factors associated with this complication. Prospective, observational study. Patients diagnosed with DKA hospitalized in the general care ward were included. Data on phosphatemia, glycemia, acid-base status, and IRS amount (U/kg) received were recorded at baseline and after 24 h of treatment. Hypophosphatemia was defined as values below 2.5 mg/dl. The correlation between initial phosphate and at 24 h of treatment was evaluated; the incidence of hypophosphatemia at 24 h was expressed as a percentage of the total number of patients. 30 patients were included, 15 were female, mean age 11.4 ± 3.2 years. At 24 h of treatment with IRS, 36.7% (95%CI 22-55%) presented hypophosphatemia, mean value 1.9 ± 1.5 mg/dl. Initial bicarbonate < 10 mmol/L acted as a predictor of hypophosphatemia (OR 7.5; 95%CI 1.4-39.8%; p = 0.01). No patient required intravenous phosphate correction, and no associated clinical complications were observed. In the group studied, the incidence of hypophosphatemia reached 36.7% at 24 hours of treatment. Initial bicarbonate lower than 10 mmol/L was significantly associated with hypophosphatemia. No complications associated with hypophosphatemia were observed.

The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study.

Hypophosphatemia might cause respiratory and heart failure and even death. We aimed to evaluate risk factors for hypophosphatemia and refeeding-related hypophosphatemia in patients requiring parental nutrition (PN). This was a single-center, retrospective study. Clinical parameters were obtained from medical records. Serum phosphate (inorganic phosphorus) was measured by photometric analysis. Hypophosphatemia was confirmed when serum phosphate level was less than 0.8mmol/L (≈2.5mg/dl). Refeeding related hypophosphatemia was confirmed if serum phosphate level had a decrease of 0.16mmol/L or more from baseline and if the final assessment was below 0.65mmol/L. A total number of 655 (426 men and 229 women, aged 62.8 ± 14.8years) hospitalized patients requiring PN were included in the study, and 60.6% of them were patients with cancer. The average body mass index (BMI) was 21.1 ± 4.1kg/m2 and the median of serum phosphate was 0.9mmol/L (quartile range: 0.68mmol/L, 1.11mmol/L). The prevalence of hypophosphatemia was 37.6% (246/655). Older age (≥ 65years vs. < 65years), lower serum level of pre-albumin (< 160mg/L vs. ≥ 160mg/L), calcium (< 2.11mmol/L vs. ≥ 2.11mmol/L), and magnesium (< 0.75mmol/L vs. ≥ 0.75mmol/L) were associated with high risk of hypophosphatemia by multivariate logistic regression (OR ranged from 1.43 to 3.06, all p < 0.05). Refeeding related hypophosphatemia was 9.5% (16/168). Serum level of calcium at baseline was significantly lower in participants with refeeding related hypophosphatemia than those without it. Total calorie and nitrogen delivered during first week of PN period showed no obvious difference between patients with and without refeeding related hypophosphatemia. Hypophosphatemia is common (37.6%) in hospitalized patients requiring PN. Monitoring of serum level of phosphorus is necessary to facilitate early treatment of hypophosphatemia.

Frequency of hypophosphatemia in critically ill children: risk factors and outcome

Background: Phosphorus plays a vital role in maintaining metabolism and energy of body. The objective of this study was to determine the frequency, risk factors and outcome of hypophosphatemia (HP) in critically ill children admitted in pediatric intensive care unit.Methods: This retrospective study included all critically-ill children having phosphate levels within 24 hours of admission from July 2019 to December 2020. Demographic, clinical and laboratory variables were collected. HP is defined as serum phosphorus level ≤4 mg/dl in this study. Descriptive statistics along with logistic regression analysis have been reported. Results: Prevalence of HP was 53.7% (94/175). Median age was 2 year (0.5-15) and male were 58.5% (106). Serum magnesium level [2.2 (1.5-12.1) vs. 1.8 (1.2-4.0) mg/dl] and serum calcium level [8.7 (.18-10.7) 8.0 (1.8-14.0) mg/dl] were significantly low in the HP group as compared to the normo-phosphatemic group. There was no significant association of hypo-phosphataemia with admitting diagnosis, ICU therapies, and medications on univariate analysis. Hypo-phosphataemia at admission had no effect on mortality. On multivariate analysis, only male gender demonstrated independent association with HP (OR: 2.2; 95% CI 1.2-4.1; p&lt;0.01).Conclusions: HP is common in critically ill children and is significantly associated with male gender. Prospective, larger sample size studies are needed to study the prevalence and risk factors of HP at pediatric intensive care units.

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

Background: Malnutrition in children &lt; 5 years is a public health concern due to its associated high morbidity, mortality and serious long-term consequences. The World Health Organization (WHO) recommends 10 steps for the management of severe acute malnutrition (SAM) children which also involves correction of electrolyte disturbances. Treatment with diets having inadequate amounts of minerals like phosphate can result in refeeding syndrome and other abnormalities. We conducted the study among children with medically complicated SAM to evaluate their serum phosphate levels after receiving locally prepared therapeutic feeds and its associations of other factors. Methods: The study was conducted with 120 hospitalized SAM children aged 6 - 59 months with presence of other illnesses. All children were managed according to the WHO protocol and facility-based management of SAM guidelines of the government of India. Basic demographic details of the child were recorded. Weight of the child was recorded daily, while length/height and mid-upper arm circumference (MUAC) were recorded weekly. We evaluated changes in serum phosphate levels at three time points: on admission, during transition and at discharge. Binary logistic regression analysis was conducted to assess the association of hypophosphatemia with several other indicators. Results: Mean serum phosphate was 4.38 ± 1.07, 4.48 ± 1.16 and 5.13 ± 1.10 mg/dL on admission, during transition and at discharge, respectively. Hypophosphatemia was present among 30 (25%) children on admission, 28 (23.3%) children during transition and 10 (8.3%) children at discharge, which showed a decrease in the prevalence of hypophosphatemia from admission to transition and discharge using the current treatment. The finding also showed positive and significant changes in serum phosphate levels among children who were admitted without edema compared to those admitted with edema. Binary logistic regression estimates showed that older children, children with lower WAZ, hypokalemia, hyponatremia and anemia had higher odds of hypophosphatemia. Male children had lower odds of hypophosphatemia. Conclusion: The nutritional therapy with locally prepared starter and catch-up diet was effective in normalizing hypophosphatemia in the majority of children treated. Serum potassium and serum sodium levels were significantly associated with serum phosphate, indicating the need for careful monitoring of serum phosphate in the presence of hypokalemia and hyponatremia among SAM children. Int J Clin Pediatr. 2021;10(2-3):35-42 doi: https://doi.org/10.14740/ijcp458

Dietary Advice in Hemodialysis Patients: Impact of a Telehealth Approach During the COVID-19 Pandemic

ObjectiveThe purpose of this study was to assess the effect of a telehealth-delivered nutritional intervention via telephone in maintenance hemodialysis (HD) patients during the coronavirus outbreak.MethodsThis was a multicenter, observational, prospective, and longitudinal study of 156 patients undergoing maintenance HD from 15 dialysis units conducted during the COVID-19 pandemic. We assigned patients to receive dietary counseling through a phone call, according to their biochemical and nutritional parameters. Dry weight, intradialytic weight gain percentage (%IDWG), body mass index, potassium, phosphorus, calcium, calcium/phosphorus product, normalized protein catabolic rate, albumin, and hemoglobin were recorded at baseline and 1 month after nutrition counseling.ResultsThe prevalence of hyperkalemia and hyperphosphatemia decreased significantly after dietary advice. A statistically significant reduction in serum potassium and phosphorus levels was observed in patients receiving counseling for hyperkalemia and hyperphosphatemia. In addition, there was a statistically significant decrease in the prevalence of hypophosphatemia. We also observed a significant decrease in %IDWG, although no statistically significant differences were detected in patients with high %IDWG. The data demonstrated statistically significant differences in potassium and phosphorus values when the person receiving the phone contact was the patient or the caregiver. The main statistically significant differences in hypophosphatemia %IDWG were only observed when contact was made directly with the patient. No differences were observed when the contact was made through nursing homes.ConclusionOur results suggest that telehealth-delivered dietary interventions can improve the clinical and nutritional parameters of HD patients. Consequently, this strategy may be effective for promoting continuous nutritional monitoring in these patients, in particular when conducting a face-to-face option is not crucial.

Prevalence of hypophosphatemia in the ICU – Results of an international one-day point prevalence survey

Hypophosphatemia (HypoP) is associated with organ dysfunction and mortality. Despite its potential severe consequences, HypoP remains poorly characterized in terms of real prevalence and timing of onset. The primary objective was to determine the prevalence of HypoP defined as blood phosphate <0.8 and<0.65mmol/l on one particular day at international level. One-day point prevalence survey conducted by the Section of Metabolism, Endocrinology and Nutrition (MEN) of the European Society of Intensive Care Medicine (ESICM) during week 11-2020. In total, 56 adult and 4 paediatric ICUs, from 22 countries participated: 41 ICUs were mixed medico surgical, the 19 others being cardiac, medical or surgical. Phosphate measurements were performed daily in 21 ICUs, and 1-3 times per week in 39 ICUs. On D-Day 909 patients (883 adults) were present and 668/883 (75.7%) had serum/plasma phosphate determined, revealing a HypoP in 103 (15.4%) patients aged 62 [18 to 85] years. Of those, 49 patients presented phosphate <0.65mmol/l: cases of hypophosphatemia were detected at any time of patient's ICU stay. No HypoP was observed in children. A treatment protocol existed only in 41.1% of adult ICUs, independently of ICU type, or size. Only 41/98 of the HypoP patients (29/41 of patients with phosphate <0.65mmol/l) were receiving phosphate. HypoP is present at least in 15.4% of ICU patients, and may occur at any time during the ICU stay. The absence of phosphate repletion protocols in 60% of participating ICUs is an unexpected finding, and confirms the necessity for the development of ICU phosphate protocols and guidelines. NCT04201899.

Retrospective analysis of hypophosphatemia rates and other clinical parameters in patients with eating disorders.

To retrospectively assess medical services of a specialist inpatient eating disorders (EDs) unit. We retrospectively evaluated clinical parameters of 288 inpatients classified as 'moderately' or 'significantly' medically compromised between 1 January 2016 and 30 June 2019. We analysed 288 patients (mean age 32.5 [SD = 11.4] years, 96% women, 76% with anorexia nervosa). Average length of stay was 38.4 (SD = 28.4) days. Average admission body mass index (BMI) was 14.8 (SD = 1.8) kg/m2 , and 16.1 (SD = 1.9) kg/m2 at 4 weeks. At admission, 82% of patients were considered significantly medically compromised, while 6% were deemed moderately compromised. Only 5% of patients required transfer to intensive care unit. Prevalence of hypophosphatemia was 17.7%; rates did not increase significantly between years despite more assertive re-feeding processes. There was no association between risk classification at admission and change in BMI at 4 weeks (F(2,166) = 0.588, p = 0.557). BMI at admission was found to be significantly associated with clinical outcome (β = 0.92, p < 0.001). Hypophosphatemia rates did not increase despite more assertive re-feeding over 3 years. Our results provide support for a model of treatment that simultaneously addresses the medical and psychiatric sequelae of patients with severe EDs.

Phosphate Disturbance in Critically Ill Children in Zagazig University Pediatric Intensive Care Unit

Background: Phosphorus is very important for normal cellular structure (cell membrane and nucleic acids). Phosphorus has an important role in the cell metabolism, ATP production, and homeostasis. Objectives: The aim of the work was to determine the prevalence and some of risk factors of hypophosphatemia in sick children, and to evaluate the prognostic effect of serum phosphorous level on the outcome in terms of morbidity and mortality in critically ill children during their stay in the pediatric intensive care unit. Patients and methods: This prospective cohort study included a total of 50 critically ill children, attending at Department of Biochemistry and Pediatric Intensive Care Unit (PICU), Department of Pediatrics, Zagazig University Hospitals. This study was conducted between April 2017 to August 2018. Patients age ranged from 2 months to 129 months and according to serum phosphorus level cases were classified into those with hypophosphatemia and others with normal phosphate level. The severity of illness was determined by using SOFA score. Results: Revealed that there was statistically significant decrease in phosphorus level at day 1 and day 3 between hypophosphatemia and normal phosphate level groups. The prevalence of hypophosphatemia was 46% at first day of admission and 70% at third day of admission. Significant increase of PTH and total bilirubin in hypophosphatemia group, and significant decrease of calcium in hypophosphatemia group compared to normophosphatemia group. The cases were followed and compared regarding; morbidity (need for mechanical ventilation, and length of PICU stay), degree of organ failure (SOFA score) and their outcome (discharge from PICU or death). Conclusion: It could be concluded that hypophosphatemia is considered a common co-morbidity in critically ill children in PICU. Hypophosphatemia more prevalent in those with respiratory problems, and higher SOFA score.

FGF23-related hypophosphatemia in patients with low bone mineral density and fragility fractures: challenges in diagnosis and management.

Hypophosphatemia (HP) can be observed in patients evaluated for skeletal fragility. We investigated prevalence of HP among outpatients referred for low bone density or fragility fractures, HP-associated clinical and biochemical features and outcomes of recommended diagnostic algorithm in our cohort. Chronic HP (phosphate ≤ 2.7mg/dL over 6months or longer) was retrospectively investigated among 2319 patients. In renal wasting-related HP, intact FGF23 was assessed; non-suppressed FGF23 prompted the performance of 68Ga-DOTATOC PET/CT in the suspicion of tumor-induced steomalacia (TIO). Renal wasting-related HP (median 2.2, range 1.6-2.6mg/dL) was observed in 19 patients (0.82%). FGF23 levels were suppressed in two patients diagnosed with renal tubular disease, increased in one and within normal range in most patients. X-linked hypophosphatemic rickets was diagnosed in one woman. In the remaining 16 patients, highly prevalent fragility fractures (50%) and severely reduced bone mineral density were detected, though diagnostic criteria for osteomalacia were not fulfilled. 68Ga-PET was performed in nine patients and was positive in four. While intact FGF23 levels alone failed to differentiate PET's outcomes (positive: FGF23 median 70.5pg/mL; negative: 52pg/mL, P = 0.462), the coexistence of multiple biochemical and radiologic alterations performed better in prediction of PET's positivity. Mild, apparently unexplained HP is observed in 0.82% of patients with low bone density or fragility fractures. In asymptomatic patients with isolated mild hypophosphatemia, the probability of finding an underlying tumor disease is very low, and utility of extensive and expensive diagnostic workup should be carefully considered in this setting.

Vitamin D, 1,25-Dihydroxyvitamin D, FGF23, and Graft Function after Renal Transplantation.

Vitamin-D has immuno-modulatory properties besides its role in mineral and bone disorder (MBD) and could have a role in allograft outcome. Fifty-two chronic kidney disease patients on dialysis going for transplantation were prospectively studied before and after renal transplantation. FGF23, 25(OH) vitamin D, 1,25-Dihydroxyvitamin D, PTH, serum Ca, serum PO4, and e-GFR status were evaluated. Vitamin D deficiency was seen in 25.0% of recipients before transplant (26.09 ± 12.19 ng/mL) and in 48.1% at 6 months post-transplant (23.36 ± 15.11 ng/mL). 1,25-(OH)2D levels before transplant were 102.37 ± 108.44 pmol/L, which were less than control (143.30 ± 108.0 pmol/L) and decreased further to 46.20 ± 42.11 pmol/mL at 3 months and started increasing to 78.37 ± 60.12 pmol/mL at 6 months post-transplantation without vitamin D supplementation. The prevalence of hypophosphatemia after transplantation was 32.0%, hyperkalemia was 12.0%, elevated intact PTH levels at 3 and 6 months after transplant were seen in 66.7% and 30.8% patients, respectively. FGF-23 levels were high in 72.5% of patients before transplant (495.94 ± 690.68 pg/mL) and decreased to normal levels at 3 months post-transplant (31.63 ± 14.17 pg/m) (control 32.07 ± 9.78 pg/mL). Serum intact PTH levels were 379.54 ± 281.27 pg/mL before transplant and came down to 103.96 ± 68.34 at 3 months and 69.87 ± 116.03 at 6 months post-transplantation. There was trend of higher e-GFR at 1 year post-transplant in patients without vitamin D deficiency (levels ≥30 ng/mL). The dysregulated mineral metabolism continues in post-transplant despite improvement in renal function and normalization of FGF-23.

Abstract P-555: PHOSPHATE IMBALANCE IN INTENSIVE CARE PATIENTS AFTER NORWOOD, BIDIRECTIONAL GLENN, HEMI-FONTAN AND FONTAN PROCEDURES.

Aims & Objectives: Hypophosphatemia is commonly seen in critically ill children and has been shown to hamper clinical recovery. Patients after surgical palliation of HLHS are prone to develop this disturbance as they require large doses of medications known to decrease serum phosphorus levels. Moreover, deleterious effects of hypophosphatemia on the cardiopulmonary system can be especially harmful to those patients. Methods We conducted a retrospective review of the medical records of children consecutively admitted to our PICU between October 2015 and November 2017, immediately after Norwood, Glenn or Fontan procedure. The following data were recorded: type of procedure with assigned Aristotle Basic Complexity Score, duration of cardiopulmonary bypass, serum phosphorus levels monitored during the first 3 days of PICU admission, hemodynamic parameters, medications, use of blood products, duration of mechanical ventilation and PICU length of stay. Results 76 children were included in the study, with a median age of 6,2 months (range: 2d - 75.7m).Throughout the study period decreased serum phosphorus levels occurred in 32 patients (42.1%), and the prevalence of hypophosphatemia on D0, D1, and D2 was 2.6%, 23.7%, and 23.7%. No association between factors previously described in the literature and hypophosphatemia was observed, except for the use of furosemide at a mean dose of over 2 mg/kg/day. Conclusions Hypophosphatemia is highly prevalent in children after staged surgical palliation of HLHS, especially in those receiving high doses of furosemide. Given the greater susceptibility and potential complications, serum phosphorus levels should be routinely measured after the surgery, so that appropriate replacement therapy may be started.

Mineral Disorders in Adult Inpatients Receiving Parenteral Nutrition. Is Older Age a Contributory Factor?

Parenteral nutrition (PN)-dependent adults and elderly individuals who are admitted to hospital treatment are potentially susceptible to mineral disorder complications due to depleted physiological reserves, loss of lean body mass, and increased fat mass, thus worsening inflammation. The purpose of this study is to evaluate the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia prior and within the first 7 days of PN infusion. Furthermore, whether malnutrition and old age are associated with these disorders was also investigated. This study included a historical cohort of adult patients, and 1,040 patients whose information was prospectively entered in the database were evaluated. Of the 781 patients, 27.3% were ≥65 years, 80.9% had undergone surgical treatment, 74.3% were in the intensive care unit, and 17.9% died during the hospitalization period. About 17.1% patients were malnourished. Protein energy malnutrition (PEM) was observed in 31.9% of the elderly patients and 27.1% of adults in general. Hypophosphatemia, hypokalemia, and hypomagnesemia were more prevalent before the start of PN infusion (D0: 214 [18.4%]), and new events were more common during the first 2 days of PN infusion (D1: 283 [23.1%]; D2: 243 [20.1%]. Elderly patients were more susceptible to developing hypophosphatemia (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.29-2.19; p<0.001). Patients with PEM were also more susceptible to hypophosphatemia (OR: 3.75; 95% CI: 1.13-12.47; p=0.036). Hypophosphatemia, hypokalemia, and hypomagnesemia were frequently observed in hospitalized adults and elderly patients before and particularly during the first 2 days of PN infusion. Elderly patients and patients with PEM are more susceptible to developing hypophosphatemia.

Hypophosphatemia in critically ill children

Introduction: Hypophosphatemia is a common disorder in critically ill patients, and is associated with myasthenia, especially in respiratory muscles, and respiratory infections. This study was conducted to describe the prevalence of hypophosphatemia in children hospitalized in the pediatric intensive care unit (PICU) of Children’s Hospital in Tabriz, Iran, in 2014-2015. Methods: In this descriptive study, medical records of all children admitted to the PICU of the children’s university hospital affiliated to Tabriz University of Medical Sciences were collected from archives of the hospital from 2014-2015 upon adopting permission. The medical records were examined in terms of demographic information, clinical diagnosis of the disease, serum phosphate level, nutritional status, therapeutic interventions, and other underlying specifications. The data were analyzed using SPSS software and descriptive tests. Results: Of the 83 eligible medical records, 45 records belonged to boys, and 38 records belonged to girls. The most prevalent and the least prevalent diseases in these children were acute pulmonary disease (57.8%) and septic shock (1.2%) respectively. Regarding the nutritional status, 38.6% of the children suffered malnutrition. Phosphorus deficiency was prevalent in the first day in 10.8% of the children, and abnormal levels of phosphorus were observed from the fourth to the sixth day in 26.5% of the children, which increased to 34.9% from the seventh to the tenth day. Conclusion: This study showed no statistically significant correlation between sex and prevalence of hypophosphatemia. Type of disease was not significantly associated with the level of phosphorus. Moreover, the patients’ nutritional status was not significantly associated with the prevalence of hypophosphatemia.

Hypophosphatemia, Hypomagnesemia, and Hypokalemia in Pediatric Patients Before and During Exclusive Individualized Parenteral Nutrition.

Hypophosphatemia, hypomagnesemia, and hypokalemia occur in patients receiving parenteral nutrition (PN), mainly when the body's stores are depleted due to fasting or inflammation. Although these disorders are potentially fatal, few studies have reported the incidence in the pediatric population. This study evaluated, in a historical cohort of pediatric patients, the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia until 48 hours before initiation of PN infusion (P1) and from days 1-4 (P2) and days 5-7 (P3) of PN infusion and investigated if malnutrition, calories, and protein infusion were correlated to these disorders. Malnutrition was present in 32.8% (n = 119) of the subjects; 66.4% of the patients were in the pediatric intensive care unit. Survival rate was 86.6%. P1 had the highest prevalence of mineral disorders, with 54 events (58.1%; P2, n = 35, 37.6%; P3, n = 4, 4.3%). Hypokalemia events were related to malnutrition (odds ratio, 2.79; 95% confidence interval, 1.09-7.14; P = .045). In the first 7 days, infused calories were below the amount recommended by current guidelines in up to 84.9% of patients, and protein infused was adequate in up to 75.7%. Protein infused above the recommendation in the first 4 days was related to hypomagnesaemia (odds ratio, 5.66; 95% confidence interval, 1.24-25.79; P = .033). Hypophosphatemia, hypokalemia, and hypomagnesemia were frequent in hospitalized pediatric patients before and during the first 4 days of PN infusion. Patients with malnutrition had more chances of having hypokalemia, and those who received high protein infusion had an increased chance of developing hypomagnesemia.

P-347: Prevalence of hypophosphatemia and relation to undernutrition in hospitalized geriatric patients

P-347: Prevalence of hypophosphatemia and relation to undernutrition in hospitalized geriatric patients

Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition.

To report the prevalence of hypophosphatemia during the first week of life in preterm infants receiving aggressive parenteral nutrition and to analyze population variables associated with severe hypophosphatemia. A retrospective cohort of 61 neonates below 1250 g birth weight consecutively born at Hospital Italiano de Buenos Aires exposed to high caloric and protein intake from the first day of birth. Primary outcome was hypophosphatemia (phosphate <4 mg dl(-1)). A one-sample mean comparison test was used to compare our sample with a hypothesized population mean. The prevalence of hypophosphatemia was 91% (95% confidence interval (CI) 82 to 97%). The mean phosphatemia value was 2.52 mg dl(-1) (95% CI 2.18 to 2.86), significantly different from the hypothesized population mean (P<0.001). Patients with severe hypophosphatemia (<2 mg dl(-1)) were smaller. They presented with sepsis more frequently and received more vasoactive drugs and mechanical ventilation. The prevalence of hypophosphatemia in this group of preterm infants is high. The potential association with adverse clinical outcomes deserves further research.

Predictors of hypophosphatemia during refeeding of patients with severe anorexia nervosa.

Hypophosphatemia of refeeding is one of the most dangerous complications seen during the treatment of patients with anorexia nervosa. Although easily detectable and treatable, hypophosphatemia is under-recognized as a complication of refeeding. Specific risk factors for the development of hypophosphatemia are likely to exist among patients with severe anorexia nervosa. The purpose of this study was to identify clinically useful markers that may predict the development of or protection from hypophosphatemia during refeeding. We conducted a retrospective case-control study of 123 patients with severe anorexia nervosa admitted for medical stabilization at the ACUTE Center for Eating Disorders between October 1, 2008 and December 31, 2013. Risk factors for refeeding hypophosphatemia were determined by multivariate logistic regression from clinical parameters and laboratory values measured at the time of admission. The prevalence of hypophosphatemia was 33.3% (41 of 123 patients). Higher hemoglobin was the only risk factor associated with a higher odds of developing hypophosphatemia (adjusted odds ratio [aOR], 1.56 [95% confidence interval [CI], 1.12-2.18]). Statistically significant protective factors against the development of hypophosphatemia were observed with higher body mass index (aOR, 0.54 [95% CI, 0.39-0.75]), higher serum potassium (aOR, 0.29 [95% CI, 0.14-0.62]), and higher serum prealbumin (aOR, 0.91 [95% CI, 0.84-0.99]). Four independent factors associated with refeeding hypophosphatemia were identified. Identification of findings which correlate with hypophosphatemia, or the lack thereof, has the potential to facilitate appropriate triage of patients with anorexia nervosa for closer monitoring during refeeding.

Hypophosphataemia with non-tenofovir-containing antiretroviral therapy

Hypophosphataemia with tenofovir (TDF) treatment has been well described. The role of HIV infection and of other antiretroviral (ART) agents in hypophosphataemia has received less attention. The aim of this study was to determine the prevalence of hypophosphataemia in HIV-positive adults. We measured the fasting plasma phosphate level and estimated glomerular filtration rate (eGFR) in 123 HIV-positive patients. A total of 26% had hypophosphataemia and 11% had hypophosphataemia of grades 2-4 (0.65 mmol/L or less). Hypophosphataemia of any grade was more frequent in those who were ART-treated than ART-naive (35% versus 10%; P = 0.0001). Multiple linear regression analysis showed no significant association between phosphate level and gender, TDF status, duration of ART, duration of HIV infection and eGFR. Increasing age was significantly associated with a very small rise in phosphate level. Isolated hypophosphataemia was significantly more frequent in HIV-positive subjects receiving ART than ART-naive individuals, irrespective of the drug regimen.