Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor

Abstract

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.

Metabolic and hormonal changes during the refeeding period of prolonged fasting

“…This required overnight i.v. intervention as mentioned earlier (6). While serum transaminases (AST and ALT) were normal at the end of the fast, elevated concentrations were detected by day 10 (Table 3).…”

Phosphorus and Calcium

“…Some patients will require multiple doses over several days to completely correct hypophosphatemia, especially those with severe malnutrition/refeeding syndrome, those with P depletion, and critically ill patients. 57,61,62,65,70,74 Finally, when using weight-based dosing, there are no definitive data or recommendations for "adjusting" weight in obese patients or what threshold should be used to adjust weight (eg, using a percentage above ideal body weight [IBW] or based on body mass index). Total body water is slightly higher in males than in females, and adipose tissue is composed of approximately 10%-30% water.…”

Refeeding syndrome: what it is, and how to prevent and treat it

“…Terlevich et al reported efficacy of 50 mmol phosphate infused into a peripheral vein over 24 hours in 30 patients with no pre-existing renal dysfunction on general wards. 17 Further infusions may be required and so careful monitoring of blood levels is required. Caution is needed in patients with existing renal impairment, hypocalcaemia (which may worsen), or hypercalcaemia (which may result in metastatic calcification).…”