Effect of Intravenous Electrolyte Supplementation on Refeeding Syndrome for Patients Initiated on Parenteral...

Background: Refeeding syndrome (RS) is a potentially life-threatening condition, marked by decreases in serum phosphorus, potassium, or magnesium, that commonly occurs in patients who receive parenteral nutrition (PN) after a period of inadequate caloric intake. Objective: To compare the occurrence and severity of RS in hospitalized patients who received intravenous (IV) electrolyte supplementation versus those who did not receive IV electrolyte supplementation prior to initiation of PN. Methods: This single-center, retrospective cohort study included adult patients hospitalized over a 10-year period who received PN. The primary outcome was the occurrence of RS in each group (decrease in serum phosphorus, potassium, or magnesium of 10% or more from baseline within 5 days of PN initiation). Results: A total of 124 patients were included in the study, with 62 patients in each group. Fifty-two patients (83.9%) in the IV electrolyte supplementation group developed RS of any severity compared to 48 patients (77.4%) in the no IV electrolyte supplementation group (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 0.62 to 3.74, P = 0.4). The IV electrolyte supplementation group developed more mild cases of RS (OR = 2.48, 95% CI = 1.14 to 5.40, P = 0.02), had a lower median decrease in serum phosphorus (median difference [MD] = -6.0, 95% CI = 10.9 to <-0.1, P = 0.03), and had lower in-hospital mortality (OR = 0.25, 95% CI = 0.09 to 0.74, P = 0.008). There were no significant differences for other secondary outcomes. Conclusion: Overall occurrence of RS was not significantly different between groups. However, some findings were suggestive of benefit associated with IV electrolyte supplementation.