Severe Hypophosphatemia in Hospitalized Patients

Background: The refeeding syndrome (RS) is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, mainly hypophosphatemia, fluid retention and dysfunction of various organs and systems, which can result in significant morbidity and occasionally death. Objective: To examine the incidence of death cases and death causes following nasogastric tube (NGT) feeding initiation in frail elderly with particular reference to RS. Methods: Forty patients with feeding problems for at least 72 h before restarting of alimentation by NGT were included. Excluded were those in any critical clinical situation. Clinical parameters and nutritional assessment were recorded before and after refeeding. Blood samples were taken before, daily for the first 3 days and 1 week after refeeding initiation. Results: During the 1st week of refeeding, 9 patients (22.5%) died and within 1 month 10 more, summing to 47.5%. Most deaths were due to infectious causes [15 out of 19, (79%)]; some were due to no obvious reason [4 out of 19, (21%)]. Significant electrolyte changes were observed in the 2–3 days following refeeding. Significant were the decreases in phosphorus and elevations in potassium and lymphocytes (day 7). We found no correlations between the severity of decreases in levels of phosphorus and mortality. Conclusions: Mortality after NGT feeding initiation was high, mainly due to infectious complications. However, in a considerable number of patients hypophosphatemia was noted, suggesting that RS could be a contributory factor of mortality. Since this is a treatable condition, more attention should be paid to detecting and coping with this problem.

show abstract

“…This in contrast to an incidence of ! 0.5% of hypophosphatemia among the patients in other hospital wards [17] .…”

mentioning

confidence: 91%

Mortality after Nasogastric Tube Feeding Initiation in Long-Term Care Elderly with Oropharyngeal Dysphagia – The Contribution of Refeeding Syndrome

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Hypophosphatemia is encountered in hospitalized medical and surgical patients but may be even more prevalent in patients receiving nutrition support. [1][2][3][4] This metabolic complication can occur as the result of phosphorus depletion or due to a shifting of phosphorus to the intracellular compartment. Depletion of total body phosphorus can be encountered in nutritionally wasted patients, such as those with cancer cachexia, HIV infection, and patients with chronic alcohol consumption.…”

mentioning

confidence: 99%

A New Graduated Dosing Regimen for Phosphorus Replacement in Patients Receiving Nutrition Support

Brown

Dickerson

Morgan

et al. 2006

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…Urinary phosphorus > 3.2 mmol (100 mg)/day indicates renal loss, while a level < 3.2 mmol (100 mg)/day indicates either nonrenal loss or a transcellular shift. (12) In our patient, urine phosphorus concentration was very low at 1.0 mmol/L (3.1 mg/dL) and 1.49 mmol/L (4.6 mg/dL) at two different measurements. The estimated 24-hour urinary phosphorus was very much less than 32 mmol (100 mg)/day.…”

Section: Discussionmentioning

confidence: 45%

A case of Gitelman syndrome with severe hyponatraemia and hypophosphataemia

Ali¹,

Masood²,

Yaqub³

et al. 2013

SMedJ

View full text Add to dashboard Cite

Gitelman syndrome (GS) is a renal tubular disorder of the thiazide-sensitive sodium chloride cotransporter, which is located in the distal tubule of the loop of Henle. We present a rare case of GS complicated by severe hyponatraemia and hypophosphataemia. A 17-year-old boy was admitted to our institution with fever and lethargy. The workup revealed typical features of GS, i.e. hypokalaemia, hypomagnesaemia and metabolic alkalosis. In this report, we discuss the differential diagnoses and rationale for accepting GS as the most likely diagnosis. This case was complicated by severe hyponatraemia (115 mmol/L) and hypophosphataemia (0.32 mmol/L). We concluded that the syndrome of inappropriate secretion of antidiuretic hormones could not be ruled out and that respiratory alkalosis was the most likely aetiology of hypophosphataemia. This case report also generates an interesting discussion on water and electrolyte metabolism.

show abstract

Severe Hypophosphatemia in Hospitalized Patients

Cited by 97 publications

References 12 publications

Mortality after Nasogastric Tube Feeding Initiation in Long-Term Care Elderly with Oropharyngeal Dysphagia – The Contribution of Refeeding Syndrome

Mortality after Nasogastric Tube Feeding Initiation in Long-Term Care Elderly with Oropharyngeal Dysphagia – The Contribution of Refeeding Syndrome

A New Graduated Dosing Regimen for Phosphorus Replacement in Patients Receiving Nutrition Support

A case of Gitelman syndrome with severe hyponatraemia and hypophosphataemia

Contact Info

Product

Resources

About