Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor

Area of Science:

• Clinical Nutrition
• Critical Care Medicine
• Biochemistry

Background:

• Refeeding syndrome can cause severe hypophosphataemia, necessitating intravenous phosphate replacement.
• Current phosphate replacement regimens are often inadequate and complex.
• Limited evidence exists for optimal intravenous phosphate replacement strategies.

Purpose of the Study:

• To evaluate the effectiveness and safety of a 50 mmol intravenous phosphate infusion (Phosphates Polyfusor) for treating severe hypophosphataemia in refeeding syndrome.
• To assess serum phosphate, creatinine, and calcium levels post-infusion.
• To monitor for adverse events.

Main Methods:

• A prospective study involving 30 patients with refeeding syndrome and severe hypophosphataemia (< 0.50 mmol/L) and normal renal function.
• Patients received a single 50 mmol intravenous phosphate infusion.
• Serial monitoring of serum phosphate, creatinine, and calcium for 4 days, alongside adverse event tracking.

Main Results:

• Within 24 hours, 37% of patients normalized serum phosphate, and 73% exceeded 0.5 mmol/L.
• Within 72 hours, 93% of patients achieved serum phosphate levels of ≥ 0.50 mmol/L.
• No renal failure occurred; three instances of transient mild hyperphosphataemia and four of mild hypocalcaemia were observed.

Conclusions:

• The 50 mmol intravenous phosphate infusion is the most effective regimen described for severe hypophosphataemia in refeeding syndrome.
• This approach demonstrated a high success rate in normalizing phosphate levels within 72 hours.
• The treatment was safely managed on general wards for patients with refeeding syndrome.