High prevalence of Hypophosphataemia amongst patients with infectious diseases. A retrospective study

Abstract

Objectives. To describe the prevalence of hypophosphataemia amongst all patients treated during 1993 for infectious diseases. The associations between serum C-reactive protein, serum albumin and white blood cells in blood were studied amongst hypophosphataemic patients. Comparisons were made according to the severity of infection. Design. A retrospective study of the prevalence of hypophosphataemia, and a case-control study amongst a subgroup of patients. Setting. The Department of Infectious Diseases, University Hospital, Umea Ê, Sweden. Subjects. For the prevalence study all 967 patients (449 women and 518 men) treated during 1993 were included. In the case-control study, 108 cases, with serum phosphate # 0.64 mmol L 21 , 216 ageand sex-matched controls with serum phosphate . 0.82 mmol L 21 (men) and . 0.86 mmol L 21 (women), respectively, were included.Results. In 402 of 967 patients (42%) at least one serum phosphate value was below the reference level. Hypophosphataemia was found in 573 of 1966 blood samples (29%). Severe hypophosphataemia (, 0.30 mmol L 21 ) was seen in 1.2% of the patients (0.9% of blood samples). The prevalence of hypophosphataemia was higher amongst women than amongst men. In the case-control study, the serum C-reactive protein and the number of white blood cells was higher amongst the cases compared with the controls (124 vs. 94 mg L 21 and 11.4 vs. 9.3 cells/L 3 10 9 , respectively). The multiple logistic regression showed a 4-fold higher risk of having low serum phosphate in patients with severe infection, compared with mild infections. None of the other variables (albumin, days of hospital stay or white blood cells in blood) increased the risk for hypophosphataemia. Conclusions. The high prevalence of low serum phosphate levels and the increased risk of having low levels in severe infections shown in this study needs further attention.

Factors contributing to the development of hypophosphataemia when refeeding using parenteral nutrition

“…A trend towards a protective effect of higher levels was claimed at an infectious diseases hospital (P = 0.21) [6]. Low albumin levels predict disease not protein status and is likely to be lower in any patient during illness, especially the elderly and in those with saline overload [25].…”

“…Hypophosphataemia from all causes is relatively common in hospital patients occurring in the elderly [3], surgical [4] and cancer patients [5] and those with severe sepsis [6]. It is a known side effect of several prescribed medicines see Box 1 [7,8].…”

Hypophosphatemia in meningococcal sepsis

“…Severe hypophosphatemia was observed even in the presence of normal blood gases and prior to initiation of intravenous fluid administration [3]. Later, hypophosphatemia was also demonstrated for adult patients with pneumonia and other infections, mostly bacterial [4,5,6]. We reported that transient hypophosphatemia is a relatively frequent phenomenon in children admitted with bacterial infections [7].…”

“…Injection of TNF-a or IL-6 in mice resulted in a marked decrease of their serum phosphate concentrations, suggesting a causative role for these cytokines in the pathogenesis of hypophosphatemia [6]. Håglin et al [5] reported that hypophosphatemic patients had a higher mean C-reactive protein level (CRP) than the normophosphatemic group. The prevalence of hypophosphatemia was higher in pediatric patients with elevated CRP levels, reaching 61% in children with pneumonia and CRP>150 mg/l [7].…”

Hypophosphataemia in Critically Ill Children

“…[3] Three main mechanisms lead to hypophosphataemia: long-term low intake, decreased absorptive state, intracellular redistribution, and increased renal tubular losses. [4][5][6][7][8] Symptoms of hypophosphataemia tend to be nonspecific in the majority of cases and include fatigue and irritability. However, severe hypophosphataemia (Less than 1.0 mg/dL) may lead to more serious problems [4] such as reduced diaphragmatic contractility, [9] cardiac arrhythmias, [10] myocardial reduction, and severe congestive cardiac insufficiency in the postoperative period of cardiac surgery.…”