Summary Background:  Severe hypophosphataemia associated with refeeding syndrome requires treatment with intravenous phosphate to prevent potentially life‐threatening complications. However, evidence for replacement regimens is limited and current regimens are complex and replace phosphate inadequately. Aim:  To assess the effectiveness and safety of 50 mmol intravenous phosphate infusion, given as a ‘Phosphates Polyfusor’, for the treatment of severe hypophosphataemia in refeeding syndrome. Methods:  Patients with refeeding syndrome and normal renal function received a Phosphates Polyfusor infusion for the treatment of severe hypophosphataemia (< 0.50 mmol/L). The outcome measures were serial serum phosphate, creatinine and calcium concentrations for 4 days following phosphate infusion and adverse events. Results:  Over 2 years, 30 patients were treated. Following treatment, 37% of cases had a normal serum phosphate concentration and 73% had a serum phosphate concentration of > 0.5 mmol/L within 24 h. Ten patients required more than one Phosphates Polyfusor infusion. Within 72 h, 93% of cases had achieved a serum phosphate concentration of ≥ 0.50 mmol/L. No patient developed renal failure. Three episodes of transient mild hyperphosphataemia were recorded. Four patients developed mild hypocalcaemia. Conclusions:  This is the largest published series of the use of intravenous phosphate for the treatment of severe hypophosphataemia (< 0.50 mmol/L), and is the most effective regimen described. All patients had refeeding syndrome and were managed on general wards.

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W HETHER androgen deficiency is of the severest grade, as in eunuchism, or of less severe grade, as in eunuchoidism, and whether it is of testicular or of hypophyseal origin, the testes are almost invariably aplastic or atrophic and in consequence distinctly small. To find normalsized testes in an individual who otherwise has all the attributes of a eunuch is an impressive sight and is the key to the syndrome to be described: The finding of normal or nearly normal-sized testes under such circumstances indicates two simple facts: a) that eunuchism is not testicular failure, but androgen deficiency; and b) that testicular mass depends largely on the bulk of the tubules present.Eunuchs and eunuchoids are almost invariably sterile and, so far as we can judge from our experience and that of others, there is seldom spermatogenesis to be demonstrated by testicular biopsy. In the 5 patients described here, there were moderate numbers of spermatozoa in almost all tubules prior to treatment; and in 2 there were normal numbers of sperm in the semen. Hurxthal et al. (1) reported 5 eunuchoid patients treated with testosterone and chorionic gonadotropin, who showed spermatogenesis after treatment. In 3 of his cases the absence of sperm in the semen before