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Hypophosphatemia and risk of refeeding syndrome in critically ill patients before and after nutritional therapy

Amanda Coelho Ribeiro1, Diana Borges Dock-Nascimento2, João Manoel Silva3,4

  • 1Nutricionista, Mestre em Ciências da Saúde pelo Programa de Pós-Graduação em Ciências da Saúde da Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil.

Revista Da Associacao Medica Brasileira (1992)
|October 7, 2020
PubMed

Insights

Hypophosphatemia is common in critically ill patients and increases after nutritional therapy (NT) begins, raising refeeding syndrome (RFS) risk, particularly with parenteral nutrition.

Area of Science:

  • Critical Care Medicine
  • Clinical Nutrition
  • Biochemistry

Background:

  • Refeeding syndrome (RFS) is a risk in critically ill patients.
  • Hypophosphatemia serves as a key marker for RFS.
  • Nutritional therapy (NT) initiation can precipitate RFS.

Purpose of the Study:

  • To determine the prevalence of hypophosphatemia before and after NT initiation.
  • To evaluate hypophosphatemia as a marker for RFS in critically ill patients.

Main Methods:

  • Retrospective cohort study of 917 adult ICU patients.
  • Serum phosphorus levels measured at admission (P1) and post-NT (P2).
  • Hypophosphatemia defined as phosphorus <2.5mg/dl.

Main Results:

  • Hypophosphatemia increased significantly from P1 to P2 (25.6% to 34.9%).
  • Malnourished patients experienced a greater drop in serum phosphorus post-NT.
  • Parenteral nutrition was more strongly associated with hypophosphatemia than other feeding methods.

Conclusions:

  • Critically ill patients have a high prevalence of hypophosphatemia at admission, increasing RFS risk post-NT.
  • Malnourished patients and those on parenteral nutrition face elevated RFS risk.
  • Early identification and monitoring of hypophosphatemia are crucial during NT.
Abstract

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