Approach to hypophosphataemia in intensive care units - a nationwide survey

Evidence-based guidelines for monitoring of serum phosphate levels and for the treatment of hypophosphataemia in critically ill patients are lacking. The aim of this survey was to evaluate current practice with respect to diagnosis and treatment of hypophosphataemia in critically ill patients among intensive care unit (ICU) physicians in the Netherlands.

A survey was conducted among all hospitals with an ICU in the Netherlands. Paediatric ICUs were excluded from participation. A questionnaire was sent, with questions on practice regarding serum phosphate monitoring and treatment of hypophosphataemia. Respondents returned the questionnaire either by mail or through a web-based survey.

A response was received from 67÷89 ICUs (75%). Respondents mentioned renal replacement therapy, sepsis and malnutrition, as well as surgery involving cardiopulmonary bypass as the most important causes of hypophosphataemia in intensive care unit patients. Of all respondents, 46% reported to measure serum phosphate levels on a daily basis, whereas in 12% serum phosphate levels were measured only on clinical indication. Less than half of the respondents had some sort of guideline for correction of hypophosphataemia. In a vast majority (79%), correction of hypophosphataemia was reported to start with serum phosphate levels.