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

Hortêncio, Taís Daiene Russo; Nogueira, Roberto José Negrão; Marson, Fernando Augusto Lima; Ribeiro, Antonio Fernando

doi:10.1177/0884533615627266

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Reported that hypokalemia is associated with poor nutritional status in ambulatory peritoneal dialysis patients. Patients with malnutrition increased risk of hypokalemia because of insufficient intake, excessive loss and electrolyte distribution (Hortencio et al, 2016). Furthermore, low levels of APTT, EOS, and PCT reflecting the status of coagulopathy or anemia were significantly associated with postoperative hypokalemia in this study.…”

Section: Discussionmentioning

confidence: 47%

Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

Zeng

Han³

et al. 2021

PeerJ

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Objective To develop and validate a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma (PA). Methods This retrospective cohort study included 205 patients with PAs between January 2013 and April 2020 in the Sun Yat-sen Memorial Hospital, Guangzhou, China. The patients were randomly classified into either a training set (N = 143 patients) and a validation set (N = 62 patients) at a ratio of 7:3. Variables, which were identified by using the LASSO regression model were included for the construction of a nomogram, and a logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) in the training set. The area under the curve (AUC) was used to evaluate the performance of the nomogram for predicting hypokalemia. Multivariate logistic regression analysis with a restricted cubic spline analysis was conducted to identify a potential nonlinear association between the preoperative index and hypokalemia. Results The incidence of hypokalemia was 38.05%. Seven preoperative indices were identified for the construction of the nomogram: age, type of PA, weight, activated partial thromboplastin time, urea, eosinophil percentage, and plateletocrit. The AUCs of the nomogram for predicting hypokalemia were 0.856 (95% CI [0.796–0.915]) and 0.652 (95% CI [0.514–0.790]) in the training and validation sets, respectively. Restricted cubic splines demonstrated that there was no nonlinear association between hypokalemia and the selected variables. Conclusion In this study, we constructed a preoperative indices-based nomogram that can assess the risk of hypokalemia after the surgical treatment of pituitary adenomas. This nomogram may also help to identify high risk patients who require close monitoring of serum potassium.

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Section: Discussionmentioning

confidence: 47%

Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

Zeng

Han³

et al. 2021

PeerJ

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“…1,2,[11][12][13][14] This difference may have occurred because, in general, most studies did not exclude patients receiving PN, and this nutrition route is known to be related to a decrease in serum phosphorus levels in children and adult patients. 9,10 The rarity of HPr and severe HP cases observed in our study may be related to our exclusion of patients receiving PN, in whom such complications are known to commonly occur. 9 We believe that frequent monitoring of serum phosphorus levels and prompt replacement may help detect mild HP and prevent severe HP.…”

Section: Resultsmentioning

confidence: 87%

“…Previous studies with critically ill pediatric patients show an even higher incidence of HP (42.0%–79.5%) 1,2,11–14 . This difference may have occurred because, in general, most studies did not exclude patients receiving PN, and this nutrition route is known to be related to a decrease in serum phosphorus levels in children and adult patients 9,10 …”

Section: Discussionmentioning

confidence: 99%

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Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

Springer

Hortêncio

Melro

et al. 2021

J Parenter Enteral Nutr

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Background: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake. Methods:A prospective, observational cohort study was conducted in a PICU of a quaternary hospital. Participants aged between 28 days and 14 years were included.Anthropometric and laboratory assessments were performed ≤72 h after PICU admission and repeated after 7 days for three consecutive times. Energy, protein, calcium, phosphate, and vitamin D intake per day of hospitalization were recorded individually.The Pediatric Index of Mortality 2 (PIM2) was used to determine each patient's severity score.Results: A total of 103 participants were included in the study. Hypophosphatemic events ranged from 27.2% to 37.5% among the assessments. HP was associated with high C-reactive protein levels (P = .012) and lower energy adequacy (P = .037). Serum phosphorus was inversely correlated (weak correlation) with PIM2 (P = .017). Conclusion:HP is common in critically ill pediatric patients, even when they are not receiving parenteral nutrition. It is necessary to monitor serum phosphorus levels and consider the possibility of early replacement, especially in patients showing high levels of inflammation. In addition to inflammation itself, low energy intake and illness severity were related to HP.

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“…However RS was more rigorously defined not only by the finding of hypophasphatemia [ 39 ]. Data collected retrospectively on children in the same year showed that hypophosphatemia, hypokalemia and hypomagnesimia were frequent in children receiving inpatient PN before and during the first four days after starting PN [ 40 ] . Malnourished children in this cohort were found to be more prone to develop low levels of potassium, wheras patients who received a high intravenous protein load had a higher incidence of hypomagnesaemia [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

Mantegazza¹,

Landy²,

Zuccotti³

et al. 2018

Ital J Pediatr

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BackgroundParenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children’s hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010.MethodsChildren and newborns receiving inpatient PN over a 6 months period were entered into the study and data was collected prospectively. The appropriate indications for the use of PN were based on the ESPGHAN guidelines. Recorded complications were divided into metabolic, central venous catheter (CVC) related, hepatobiliary and nutritional.ResultsA total of 303 children (67 newborns) were entered into the study. The main indications for the start of PN were critical illness (66/303), surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (95.5% of newborns, 90.7% of children). PN was considered inappropriate in 12/303 patients and equivocal in 13. The mean PN duration was 18 days (1–160) and the incidence of complications correlated to the length of PN prescribed. Metabolic, hepatobiliary and CVC related complications affected 74.6, 24.4, 16.4% of newborns and 76.7, 37.7 and 24.6% of children respectively.In relation to the appropriate indications for the start of PN our results mirrored those reported by the NCEPOD audit (92.4% of newborns and 88.6% children). However, the incidence of metabolic disturbances was higher in our cohort (74.6% vs 30.4% in children, 76.7% vs 14.3% in newborns) but CVC related complications lower amongst our newborns (16,4% vs 25%).ConclusionsAlthough the indications for inpatient PN in children is mostly justified, there is still a proportion who is receiving PN unnecessarily. PN related complications remain common. There is a need for better education amongst health professionals prescribing PN and access to nutritional support teams to reduce unwanted side effects.

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

Cited by 8 publications

References 21 publications

Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition

Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

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