HYPOPHOSPHATEMIA AND REFEEDING SYNDROME IN PATIENTS AT THE SURGICAL INTENSIVE CARE UNIT, CHILDREN'S HOSPITAL 1
Main Article Content
Abstract
Background: Major causes of hypophosphatemia include prolonged malnutrition, electrolyte disturbances, and underlying conditions such as diabetes mellitus, liver failure, and renal failure. Notably, refeeding syndrome (RFS) is a critical trigger following initiation of nutritional support. During glucose metabolism, phosphate shifts intracellularly, resulting in reduced serum levels. Hypophosphatemia poses a life-threatening complication, potentially leading to cardiac, respiratory, neurological dysfunction, and increased mortality risk. The incidence of RFS varies from 0.43% to 80%. Close monitoring and timely supplementation of phosphate, potassium, and Magnesium are essential for effective management.
Objectives: This study aimed to investigate the characteristics of hypophosphatemia and RFS in patients at the Surgical Intensive Care Unit (SICU) of Children's Hospital 1 from November 2024 to September 2025. Specific objectives included determining the prevalence of hypophosphatemia, RFS, and associated risk factors.
Methods: A cross-sectional descriptive study was conducted on 128 post-surgical pediatric patients receiving parenteral nutrition (PN) for ≥2 days at the SICU from November 2024 to September 2025. Hypophosphatemia was defined as serum phosphate <0.8 mmol/L; RFS was diagnosed per NICE 2006 guidelines. Data were analyzed using SPSS 26.0 with chi-square tests (significance level p<0.05).
Results: 128 post-surgical pediatric patients receiving PN ≥2 days and hospitalized ≥2 days at the SICU. Prevalence of hypophosphatemia was 57.8%; associated risk factors included malnutrition on admission (OR=2.5), intravenous Magnesium supplementation (OR=1.83), albumin infusion (OR=15.01), and prolonged ICU stay. RFS occurred in 9.4% of cases, with 33.3% having pre-admission fasting and 73.3% malnutrition; hypophosphatemia and hypoMagnesemia were common. Therapeutic energy intervention was 48 kcal/kg/day, primarily from carbohydrates (100%), protein (75%), and lipids (33.3%).
Conclusions: Routine serum phosphate monitoring is recommended for all ICU patients, with early and safe phosphate supplementation. Risk factors for hypophosphatemia and RFS—such as suboptimal nutrition, unnecessary intravenous Magnesium, low albumin, and extended ICU stay—should be proactively managed.
Article Details
References
2. Bechard, L.J., J.S. Parrott, and N.M. Mehta, Systematic review of the influence of energy and protein intake on protein balance in critically ill children. The Journal of pediatrics, 2012. 161(2): p. 333-339. e1.
3. Beleidy A, El Sherbini SA, Elgebaly HF, Ahmed A. Calcium, Magnesium and Phosphorus deficiency in critically ill children. Egyptian Pediatric Association Gazette. 2017 Jul 1;65(2):60-4.
4. Little, B.S., et al., Hypophosphataemia definitions, incidence and associated outcomes in paediatric intensive care: A retrospective cohort study in post-cardiac surgical patients <2 years of age. J Paediatr Child Health, 2023. 59(9): p. 1075-1081
5. Martínez, A., Rodriguez A. et al., Prevalence of Refeeding Syndrome in a Pediatric Intensive Care Unit. Andes pediatrica, 2025 (AHEAD); 96(1): p.59-66
6. Savluka, O.F., et al., Effect of levosimendan on venoarterial extracorporeal membrane oxygenation weaning after pediatric cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 2023. 37: p. 65-66.
7. Schneeweiss-Gleixner, M., et al., Hypophosphatemia after Start of Medical Nutrition Therapy Indicates Early Refeeding Syndrome and Increased Electrolyte Requirements in Critically Ill Patients but Has No Impact on Short-Term Survival. Nutrients, 2024. 16(7): p. 922.
8. Stevic M, Vlajkovic-Ivanovic A, Petrov-Bojicic I, Ristic N, Budic I, Marjanovic V, Simic D. Identification and prevention of refeeding syndrome in pediatric intensive care. Srpski arhiv za celokupno lekarstvo. 2024;152(3-4):218-23.