Phosphate replacement in the critically ill: potential implications for military patients

Abstract

In our study, mild and moderate hypophosphataemia was not associated with adverse clinical outcome across most organ systems analysed. Given the current evidence and results of this study, we would suggest that there is a trend towards over-replacement of phosphate, representing a potential clinical safety issue as well as clear financial implications.

Clinical and laboratory features associated with serum phosphate concentrations in malaria and other febrile illnesses

“…An association between platelet count and serum phosphate levels has been previously reported [1]. During malaria and sepsis, decreases in circulating platelet count are mostly due to platelet activation and an associated prothrombotic state [21,22].…”

“…Whilst hypophosphatemia can cause a variety of clinical features which are frequently seen in individuals with severe infections, such as weakness, malaise and alterations in mental status [9,16], it is uncertain whether the decrease in serum phosphate induced by fever really contributes to these manifestations. Phosphate replacement for severely ill patients with very low serum phosphate levels is common practice in many countries, but it is unclear whether this has any clinical benefit [1,29]. The potential benefits of phosphate replacement in malaria have not been evaluated, and phosphate levels are not routinely measured in malaria patients in the most endemic countries.…”

“…Therefore, there is a need to prospectively evaluate the associations between serum phosphate levels, clinical and laboratory features of malaria (particularly those associated with severity), and patient outcomes, in malaria endemic countries. Phosphate infusion is a relatively straightforward, safe, and cheap intervention [1,29], which might therefore be used in malaria patients if there was evidence to support a benefit on clinical outcomes.…”

“…The dataset supporting the conclusions of this article is included within the article and its additional files. 1…”

“…Abnormal serum phosphate levels are a common finding in seriously ill patients, and hypophosphatemia (usually defined as serum phosphate < 0.8 mmol/L) is commonly seen in patients with severe infections [1][2][3][4][5][6][7][8][9].…”