Neurological involvement in a case of hypophosphatemia. Privacy Crit Care 14, R147 (2010). Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for … Results: Patients were administered phosphate buffer via the nasogastric tube, and the doses chosen by the physicians … 10.1007/s00134-004-2333-2, English P, Williams G: Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Pathophysiology. Hypophosphatemia can cause hematologic dysfunction [46–48], insulin resistance [49], and a number of neuromuscular symptoms (Table 3). 10.1016/j.amjmed.2005.02.014, CAS  doi:10.1186/cc9215 Link to Abstract Link to FULL FREE PDF. Sex, age, disease severity represented by maximal organ system Sequential … PubMed  This might be especially relevant in patients with chronic pulmonary disease, as these patients may have higher 2,3-DPG levels to compensate for hypoxemia. Therapies instituted in the ICU, including overly aggressive renal replacement therapy 3 and erythropoietin therapy, 4 can increase the risk of hypophosphatemia. Because of the current paucity of evidence, serum phosphate levels are not routinely measured in all critically ill patients. Keywords: phosphorus, buffer, intensive care unit, critically ill Google Scholar, Daily WH, Tonnesen AS, Allen SJ: Hypophosphatemia: incidence, etiology, and prevention in the trauma patient. Hypophosphatemia has a higher incidence in certain patient groups, such as patients with diabetic ketoacidosis, sepsis, and postoperative patients. Large intravenous doses of phosphate may result in hyperphosphatemia, hypomagnesemia, hypocalcemia, and hypotension. Correction of hypophosphatemia is possible via oral or intravenous routes. Effect of hypophosphatemia on the withdrawal of mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. Among patients without any episodes of hyperphosphatemia, patients with at least 1 episode of hypophosphatemia had a higher ICU mortality than those without hypophosphatemia (P = .004). Especially patients with Gram-negative bacteremia may develop hypophosphatemia [9]. Hypophosphatemia is associated with cardiac, respiratory, immunologic, and hematologic disorders, which is a subsequence of the impaired energy metabolism. J Neurol Neurosurg Psychiatry 2003, 74: 820. Zazzo JF, Troche G, Ruel P, Maintenant J: High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Studies should focus on the association between hypophosphatemia and morbidity and/or mortality, as well as the effect of correction of this electrolyte disorder. J Am Soc Nephrol 1998, 9: 1264-1269. Therefore, further studies in larger populations are required to confirm our findings. Finally, patients with diabetic ketoacidosis commonly present with hypophosphatemia due to increased urinary phosphate excretion. Crit Care Med 1992, 20: S104. Hypophosphatemia is a frequently encountered metabolic complication in hospitalized patients, ... RTBC, B5-ICU, D4-ICU) Potassium phosphate injection has traditionally been stocked in all critical care areas at Sunnybrook campus. Hypophosphatemia is associated with respiratory muscle dysfunction, potentially resulting in (acute) respiratory failure and weaning problems [36–38]. 2018:885066618762753. Multivariate logistic regression was utilized to identify the risk factors for 28-day ICU mortality. Currently no evidence-based guideline exists for the approach to hypophosphatemia in critically ill patients. Some important limitations to our study should be acknowledged. 10.1136/pgmj.2002.004291, Buell JF, Berger AC, Plotkin JS, Kuo PC, Johnson LB: The clinical implications of hypophosphatemia following major hepatic resection or cryosurgery. Springer Nature. 2003;14(5):326–8. Google Scholar. South Med J 1987, 80: 831-835. The hypophosphatemia group had significantly longer time on CRRT when compared to control group, a median of 81.0 (lower and upper quartiles; 45.3and 188.8 h) compared to 41 h (22.0 and 59.0 h) in the normal control group. Additionally, the patients in the hypophosphatemia group had a longer ICU stay with a median of 5.5 (lower and upper quartiles; 2.0 and 10.6 days) than those in the control group, the median of which was 1.7 (lower and upper quartiles; 1.5 and 3.4 days), P < 0.05. [ 7, 12, 14, 15, 17–19, 21, 26–30] Hypophosphatemia is usually categorized … Patients will be categorized according to at-admission inorganic phosphate (Pi) level into normophosphatemia group and hypophosphatemia group (HP) (mild, moderate and severe HP). Conclusions: Refeeding hypophosphatemia occurs commonly in critically ill patients in the ICU. Below are the links to the authors’ original submitted files for images. Additional studies are required, addressing the current approach to hypophosphatemia in critically ill patients, as well as the association of hypophosphatemia with morbidity and mortality, and the effect of treatment. Riedler GF, Scheitlin WA: Hypophosphataemia in septicaemia: higher incidence in gram-negative than in gram-positive infections. Multiple studies have evaluated the efficacy and safety of intravenous phosphate repletion regimens (Table 4) [61–67]. Similar results were seen for hospital mortality. Am J Hematol 2002, 69: 223-224. In a review of clinical studies done on hypophosphatemia in pediatric intensive care unit (PICU) patients, its prevalence exceeded 50% [2]. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. adults. As established in our study, the patients in the hypophosphatemia group required more intensive and prolonged mechanical ventilation. This search yielded 1,413 articles. Berger MM, Rothen C, Cavadini C, Chiolero RL: Exudative mineral losses after serious burns: a clue to the alterations of magnesium and phosphate metabolism. As illustrated in Fig. Therefore, the detection of phosphate metabolism abnormalities in Intensive Care Unit (ICU) populations is crucial. Table 2 summarizes the reported incidence and prevalence of hypophosphatemia in surgical and medical ICU patients [7, 12, 14, 15, 17–19, 21, 26–30]. 10.1097/00003246-199507000-00009, Bollaert PE, Levy B, Nace L, Laterre PF, Larcan A: Hemodynamic and metabolic effects of rapid correction of hypophosphatemia in patients with septic shock. J Am Coll Surg 2004, 198: 198-204. In our study population, although there was no difference between the two groups in the reasons for ICU admission, but the number of septic shock patients complicated with acute renal insufficiency and received RRT therapy in hypophosphatemia group is higher than that in the control group (22.4% VS 36.5%, P = 0.01). Hypophosphatemia often develops in the postoperative phase [12–15]. Doses of up to 40 mmol of sodium phosphate, administered at a speed of up to 20 mmol per hour, are proven to be safe. Variables were obtained from electronic medical records using the patient’s hospital admission number. Salem RR, Tray K: Hepatic resection-related hypophosphatemia is of renal origin as manifested by isolated hyperphosphaturia. Although the use of renal replacement therapy leads to hypophosphatemia, no epidemiologic reports were found. These studies generally agree that aggressive phosphate supplementation is safe with phosphate doses up to 45 mmol with infusion rates up to 20 mmol per hour. Hypophosphatemia is an electrolyte disorder in which there is a low level of phosphate in the blood. All authors approved the final version of the manuscript. Intravenous therapy is generally recommended in symptomatic hypophosphatemia and phosphate levels <0.32 mmol/L. Anaesthesiology Intensive Therapy 2016, 48(5):294–299. Liu B, Cheng Y, Shen F, Wang Y, Wu Y, Yao L, Liu Y, Gou X. Hypophosphatemia is associated with poor prognosis of critically ill patients: a meta-analysis of 1 555 patientsZhonghua Wei Zhong Bing Ji Jiu Yi Xue. With the high prevalence of hypophosphatemia in critically ill patients, as well as their susceptibility to life-threatening symptoms, frequent laboratory monitoring is recommended, especially in previously mentioned high-risk groups. Binary logistic regression analysis was employed to assess the association of variables with ICU 28-day mortality. Hypophosphatemia is usually categorized as moderate (serum phosphate level of 0.32 to 0.65 mmol/L (1 to 2 mg/dl) or severe (<0.32 mmol/L (<1 mg/dl)). 10.1136/bmj.1.5646.753, PubMed Central  Multiple causal factors may be present, such as respiratory alkalosis, administration of insulin, and the use of diuretics. During correction of hypophosphatemia, phosphate may precipitate with calcium and cause hypocalcemia. Anesth Analg. Qiuye Kou. 10.1016/0002-9343(88)90065-4, Agusti AG, Torres A, Estopa R, Agustividal A: Hypophosphatemia as a cause of failed weaning: the importance of metabolic factors. J Neurosurg 2001, 94: 697-705. A total number of 1073 of adult patients were admitted to the general ICU from 2015 to 2016, of which 946 patients met the inclusion criteria. Whether maintenance of normal plasma phosphate level and correction of the hypophosphatemia in critically -ill-patients can improve outcome is currently unknown. Am Heart J. The cohort included 946 patients with a median phosphate concentration of 0.77 mmol/L (interquartile range 0.55–1.03 mmol/L). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Hypophosphatemia is a significant predictor of ventricular tachycardia after myocardial infarction [44] and a correlation with arrhythmias has been suggested in septic patients [45]. Hypophosphatemia was an independent risk factor for ICU 28-day mortality (adjusted OR = 1.5, 95% CI = 1.1–2.1, P = 0.01) in the multivariate logistic regression analysis. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. Although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it is unknown which treatment strategy is superior. Although many studies have discovered that episodes of hypophosphatemia during the ICU stay is associated with increased mortality, whether it directly leads to higher mortality or is merely a marker of disease severity in the general ICU still remains uncertain. Ann Clin Lab Sci. Makhoul N, Farah R, Jacobson L. Hypophosphatemia of prognostic value in acute exacerbation of COPD. Of the latter, rhabdomyolysis [50, 51] and central pontine myelinolysis [52, 53] are most severe. The total required amount of phosphate cannot be predicted by serum phosphate levels, as phosphate shifts between multiple body compartments. George R, Shiu MH: Hypophosphatemia after major hepatic resection. Hypophosphatemia at admission is an independent risk factor for 28-day mortality in general ICU patients. Patients with septicemia, respiratory failure and chronic obstructive pulmonary diseases were more prone to develop hypophosphatemia. Redistribution across the cell membrane is the most common cause of hypophosphatemia in ICU patients and can be caused by multiple clinical conditions [1, 3]: respiratory alkalosis-induced increase of intracellular pH causes phosphate to enter the cell by stimulating glycolysis [4]; administration of glucose and insulin also stimulates carbohydrate metabolism, during which phosphate is transported into the cells along with glucose; high serum levels of catecholamines such as epinephrine and norepinephrine, whether endogenous or exogenous, cause a decrease in serum phosphate [5]; cellular uptake of phosphate is increased under certain specific conditions such as the hungry-bone syndrome, and diseases with rapid cell proliferation such as acute leukemia; renal excretion of phosphate is increased by metabolic acidosis, and by many drugs, including diuretics, glucocorticoids [6], aminoglycosides, antiretroviral drugs, and anticancer drugs. Besides hypophosphatemia, critically ill patients frequently have multiple factors putting them at risk for neurologic alterations, and causality is not well documented. Hypophosphatemia, however, is associated with increased mortality in important patient subgroups. Privacy Patients will be categorized according to at-admission inorganic phosphate (Pi) level into normophosphatemia group and hypophosphatemia group (HP) (mild, moderate and severe HP). JPEN J Parenter Enteral Nutr 2001, 25: 152-159. PubMed  Patients who require high-flux dialysis for intoxications are especially at risk. Google Scholar, Cunha BA: Hypophosphatemia: diagnostic significance in Legionnaires' disease. Table 2 summarizes the reported incidence and prevalence of hypophosphatemia in surgical and medical ICU patients. Phosphate abnormality is common in ICU, and hypophosphatemia is an independent indicator of 28-day mortality in the general ICU population. Google Scholar. Renal phosphate handling is altered in trauma patients, resulting in inadequately increased urinary phosphate excretion. Zhao Y, Zhihai LI, Shi Y, Cao G, Meng F, Zhu W, Yang GE. The study was conducted from 1 January 2016 to 31 December 2017 after approval by the Institutional Ethics Committee of the Six Affiliated Hospital, Sun Yat-sen University. Phosphorus is a source of ATP (adenosine triphosphate) required for neurologic functions and muscular contraction. They divided the patients into two groups, the ratio of hypophosphatemia to total CVVH therapy days lower than 0.58 defined as low ratio group, and the other as high ratio group. Transplant Proc 2005, 37: 1987-1989. 10.1097/00003246-198402000-00012. 2016;352(3):317–23. statement and Daniël A Geerse. 2006;36(1):67–72. CAS  One study reports that 45% of all hospital hypophosphatemia cases occur in the ICU population [35]. Phosphorus is an essential element for all living cells, with different functions (Table 1) [1]. 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