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Hypophosphatemia in critically ill children: prevalence and associated risk factors
Juliana Fernandez Santana e Meneses1, Heitor Pons Leite, Werther Brunow de Carvalho
1Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Insights
Hypophosphatemia is common in critically ill children, affecting 61% within 10 days. Key risk factors include respiratory disease, dopamine use, and malnutrition.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Endocrinology
- Clinical Nutrition
Background:
- Hypophosphatemia is a frequently unrecognized disorder in critically ill patients.
- It can lead to significant complications if not managed promptly.
- Early identification is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of hypophosphatemia in critically ill children.
- To identify independent risk factors associated with this condition.
- To inform clinical management strategies in pediatric intensive care units.
Main Methods:
- A prospective cohort study involving 82 children admitted to a pediatric intensive care unit (ICU).
- Serum phosphorus levels were monitored for the first 10 days of admission.
- Logistic regression analysis identified independent risk factors for hypophosphatemia.
Main Results:
- The prevalence of hypophosphatemia was 61% within the first 10 days of pediatric ICU stay.
- Malnutrition was observed in 39.1% of patients and was linked to lower serum phosphorus.
- Independent risk factors identified were acute respiratory disease, dopamine use, and malnutrition.
Conclusions:
- Hypophosphatemia is highly prevalent in critically ill children during the initial 10 days of ICU hospitalization.
- Acute respiratory disease, dopamine administration, and malnutrition are significant independent risk factors.
- Clinical monitoring should prioritize these factors, especially when co-occurring, for better patient management.
Background:
Hypophosphatemia is a disorder with potential complications and is often unrecognized in critically ill patients.
Aims:
To identify the prevalence of hypophosphatemia and risk factors associated to this disorder in critically ill children.
Methods:
In a prospective cohort study, 82 children admitted consecutively to a pediatric intensive care unit (ICU) were monitored regarding phosphorus serum levels during the first 10 days of admission. The following variables were analyzed as independent for hypophosphatemia: age, gender, diagnosis at admission, malnutrition, phosphorus intake, clinical severity score at admission (pediatric index of mortality 2) and daily scores (Pediatric Logistic Organ Dysfunction), sepsis, use of dopamine, furosemide and steroids, starvation period, and refeeding. Children with a z score of less than -2 of expected weight for age or body mass index (National Center for Health Statistics, 2000) were considered malnourished. Variables significantly associated with hypophosphatemia by bivariate analysis (p < 0.1) were included in a multiple logistic regression model.
Results:
The rate of hypophosphatemia was 61% during the first 10 days of pediatric ICU stay, and 12 patients developed hypophosphatemia during the study period. Malnutrition was present in 39.1% of patients, and the sera phosphorus concentration was significantly lower in malnourished than in well-nourished children (2.6 +/- 0.7 mg/dL vs. 3.5 +/- 0.8 mg/dL, p = 0.01). The multiple logistic regression model indicated the diagnosis of acute respiratory disease (odds ratio: 3.22; confidence interval: 1.03-10.1; p = 0.04), use of dopamine (odds ratio: 8.65; confidence interval: 1.58-47.3; p = 0.01), and malnutrition (odds ratio: 3.96; confidence interval: 1.19-13.3; p = 0.02) as independent risk factors for hypophosphatemia. None of the other potential risk factors discriminated for hypophosphatemia.
Conclusions:
Hypophosphatemia was common in the first 10 days of ICU hospitalization and was associated with the diagnosis of respiratory disease, use of dopamine, and malnutrition. These factors should be taken into account during clinical follow up of critically ill children, especially when these conditions are found together.
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