Calcium, magnesium and phosphorus deficiency in critically ill children

Abstract

a b s t r a c tIntroduction: Critical illness may trigger an acute phase response which is associated with several metabolic derangements. These include hypo-and hypercalcemia, hypo-and hyperphosphatemia, hypo-and hypomagnesaemia. Method: Therefore, we conducted a prospective, non-interventional study in 10 beds intensive care unit of the at Pediatric Intensive Care Unit, Cairo University Pediatric Hospital. During 6 months period to investigate the incidence & risk factors of magnesium, phosphorus & calcium deficiency in patients admitted to the intensive care unit (ICU) on admission and followed the course of deficiency at day 3 & ten during stay. Results: Out of 70 patients, the frequency of Calcium deficiency was (34%), magnesium deficiency (31%), phosphorus deficiency (47%) on admission. Calcium and magnesium deficiency frequency changed gradually after 72 h & 10 days; in response to intravenous supplementation for deficient patients. While phosphorus level declined during follow up. Respiratory failure (87%) was the most common organ failure followed by neurological failure. Patients with hypocalcaemia on admission had a higher PELOD score (P = 0.10), coagulopathy (P = 0.044), sepsis diagnoses (P = 0.007), metabolic acidosis (P = <0.001), hyperglycemia (P = 0.006) hypomagnesaemia (P = <0.001), hypoalbuminemia (P = 0.004). While hypomagnesaemia risk factors were coagulopathy (P = 0.039), inborn error of metabolism (P = 0.039), sepsis diagnoses (P = 0.045), hypocalcaemia (P = <0.001), hypophosphatemia (P = 0.004), hypoalbuminemia (P = 0.042). Hypophosphatemia was associated with hypokalemia (P = 0.003) & hypomagnesaemia (P = 0.004). Regression analysis revealed metabolic acidosis & hyperglycemia were associated with calcium deficiency, while inborn error of metabolism and hypophosphatemia with magnesium deficiency. Risk factors for Hypophosphatemia are hypokalemia & hypomagnesaemia. Conclusion: Hypophosphatemia was the most frequent and under estimated electrolyte disturbance in our study. Ó 2017 The Egyptian Pediatric Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). IntroductionDisorders of magnesium, calcium and phosphorus are common in patients admitted to intensive care units. 1 Routine monitoring and replacement of these ions are still underemphasized. 2 Most studies focus, on individual electrolytes without taking the interrelationship between specific deficits into account. Hypocalcaemia is a common derangement in both medical and surgical patients requiring intensive care. The reported prevalence varies significantly between studies due to differences in the population studied and the cutoff values used, with published figures ranging from 15% to 88%. 3 Magnesium is the fourth most common cation in the body and second most common intracellular cation after potassium, yet its deficiency is frequently overlooked. Various studies have reported the incidence of hypomagnesemia up to 65% in ...

Hypophosphatemia in critically ill adults and children – A systematic review

“…In a monocentric retrospective study including 235'980 hospitalized children (6 months to 18 years old), severe hypophosphatemia was defined as a serum Pi 0.38 mmol/l, based on need for transfer to pediatric high-dependency (HDU) or pediatric intensive care units (PICU) as a surrogate for adverse outcome [111]. Based on a more conservative cut-off of 0.8 mmol/l, hypophosphatemia on admission to PICU, would occur in 5% to 50% of admitted patients [100,108,109,[112][113][114], even in countries with low prevalence of malnourished children [115]. Moreover, hypophosphatemia occurs during the first 3 to 7 days in PICU in 30% to 76% of stays [102,104,105,107,113].…”

“…Based on a more conservative cut-off of 0.8 mmol/l, hypophosphatemia on admission to PICU, would occur in 5% to 50% of admitted patients [100,108,109,[112][113][114], even in countries with low prevalence of malnourished children [115]. Moreover, hypophosphatemia occurs during the first 3 to 7 days in PICU in 30% to 76% of stays [102,104,105,107,113]. Risk factors on admission or during PICU-stay are: malnutrition like kwashiorkor, rickets, anorexia nervosa [101,108], refeeding syndrome [112], diabetic ketoacidosis [106], sepsis [100,115], hemofiltration [116], and total parenteral nutrition [117].…”

Дефіцит Кальцію Та Магнію В Дітей Із Гострою Дихальною Недостатністю: Проспективне Обсерваційне Когортне Дослідження

“…Електролітні порушення часто зустрічаються в пацієнтів відділення інтенсивної терапії (ВІТ) для дітей. Зміни вмісту магнію та кальцію в дітей раннього віку в критичному стані є одним із найчастіших порушень разом із порушеннями рівня фосфору сироватки крові [1,6,7]. Дефіцит магнію є поширеною проблемою серед пацієнтів у критичному стані, що корелює з вищим рівнем летальності та гіршими результатами лікування пацієнтів ВІТ.…”

“…Автори багатьох публікацій відмічають, що суплементація препаратів магнію суттєво впливає на рівень летальності серед пацієнтів із гіпомагніємією [1,2,5,6]. У нашому дослідженні всі пацієнти впродовж 1-2 діб із моменту верифікації гіпомагніємії починали отримувати магнію сульфат для корекції гіпомагніємії, що, ймовірно, і може пояснити відсутність різниці в рівнях летальності серед пацієнтів із гіпомагніємією та нормомагніємією.…”

Potential Hematology and Nutritional Complications of Bariatric Surgery

“…It is a major component of bones, DNA-RNA, ATP (the primary energy producer in the body), and phospholipids. Phosphorus is also essential for maintaining the acid-base balance in the body [100]. Deficiency is rare because phosphorus is widely available in food.…”