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. J Neurosurg 2001, 94: 697-705. Fuentes E, Yeh DD, Quraishi SA, Johnson EA, Kaafarani H, Lee J, King DR, Demoya M, Fagenholz P, Butler K. Hypophosphatemia in Enterally fed patients in the surgical intensive care unit: common but unrelated to timing of initiation or aggressiveness of nutrition delivery. J Am Coll Surg 2004, 198: 198-204. A total number of 946 patients were included at ICU admission. Intensive Care Med 1995, 21: 826-831. Patients will be categorized according to at-admission inorganic phosphate (Pi) level into normophosphatemia group and hypophosphatemia group (HP) (mild, moderate and severe HP). The consequences of hypophosphatemia for critically ill patients remain controversial. DAG, AJB, MAK, ANR, PES, and MJS participated in drafting and reviewing the manuscript. Hypophosphatemia has a higher incidence in certain patient groups, such as patients with diabetic ketoacidosis, sepsis, and postoperative patients. 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. Hypophosphatemia is even more frequent in burn-wound victims, where phosphate is lost through the skin [19, 20]. Although the use of renal replacement therapy leads to hypophosphatemia, no epidemiologic reports were found. 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. Yang Y, Zhang P, Cui Y, Lang X, Yuan J, Jiang H, Lei W, Lv R, Zhu Y, Lai E, et al. They found that, compared to the low ratio group, the high ratio group had a 1.451-fold in 28-day mortality rate (95% CI 1.103–1.910, P = 0.008). Department of Intensive Care Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven, 5623, Netherlands, Daniël A Geerse, Alexander J Bindels & Arnout N Roos, Department of Intensive Care Medicine, Medical Centre, Leeuwarden, 888, 8901, Netherlands, Department of Intensive Care Medicine, Academic Medical Center University of Amsterdam, Meibergdreef 9, Amsterdam, AZ, 1105, Netherlands, Michael A Kuiper, Peter E Spronk & Marcus J Schultz, HERMES Critical Care Group, Meibergdreef 9, Amsterdam, AZ, 1105, Netherlands, Department of Intensive Care Medicine, Gelre Hospitals location Lukas, Apeldoorn, 9014, 7300, Netherlands, Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center University of Amsterdam, Meibergdreef 9, Amsterdam, AZ, 1105, Netherlands, You can also search for this author in Lichtman MA, Miller DR, Cohen J, Waterhouse C: Reduced red cell glycolysis, 2,3-diphosphoglycerate and adenosine triphosphate concentration, and increased hemoglobin-oxygen affinity caused by hypophosphatemia. Indian J Physiol Pharmacol 2000, 44: 225-228. Effect of hypophosphatemia on the withdrawal of mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. Intensive Care Med 2004, 30: 1662-1665. Crit Care Med 1995, 23: 1204-1210. 10.1378/chest.107.6.1698, Kruse JA, Al-Douahji M, Carlson RW: Rapid intravenous phosphate replacement in critically ill patients. The study will include all patients admitted to ICU with or developing severe sepsis or septic shock within 24-hr after admission to ICU. Severe hypophosphatemia in sepsis as a mortality predictor. Am Heart J. Importantly, hypophosphatemia is among the most frequently encountered electrolyte metabolic disturbances in critically ill patients with an incidence and prevalence ranging within 2.4–100% [13, 14]. In general, hypophosphatemia is rare. Am J Clin Nutr 1997, 65: 1473-1481. As illustrated in Fig. Google Scholar, Daily WH, Tonnesen AS, Allen SJ: Hypophosphatemia: incidence, etiology, and prevention in the trauma patient. Second, we identified only the baseline measurements of the plasma phosphate level, which hindered the evaluation of plasma phosphate values over time. PubMed  Patients with hypophosphatemia had a longer ICU and hospital stays, and prolonged duration of mechanical ventilation (all P<0.05). statement and Jansen A, Velkeniers B. CAS  Although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it is unknown which treatment strategy is superior. Cite this article. 10.1056/NEJM198508153130705, Gravelyn TR, Brophy N, Siegert C, Peters-Golden M: Hypophosphatemia-associated respiratory muscle weakness in a general inpatient population. Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, Fiedler GM, Fuhrmann V, Exadaktylos AK. The study will include all patients admitted to ICU with or developing severe sepsis or septic shock within 24-hr after admission to ICU. Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study. Critical Care Hypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored. Whether hypophosphatemia itself causes higher mortality or is a marker of illness severity remains unclear. Hypothermia induces polyuresis and is associated with hypophosphatemia as well [23]. The spontaneous course of serum phosphate is not well documented in the literature, so it is insufficiently clear whether an initially low phosphate level after surgery will return to normal spontaneously. Therefore, ICU patients are routinely monitored for electrolyte disorders, and it is common practice to correct them. © 2020 BioMed Central Ltd unless otherwise stated. Intensive Care Med 1985, 11: 144-148. Br Med J 1972, 1: 273-276. It is important to investigate whether hypophosphatemia causes higher mortality in itself, or rather is associated with a higher severity of illness. Acta Chir Scand 1988, 154: 429-433. Scand J Clin Lab Invest Suppl 1996, 224: 83-87. Gaasbeek A, Meinders AE: Hypophosphatemia: an update on its etiology and treatment. O'Connor LR, Wheeler WS, Bethune JE. Patients with hypophosphatemia had a longer ICU and hospital stays, and prolonged duration … Chung PY, Sitrin MD, Te HS: Serum phosphorus levels predict clinical outcome in fulminant hepatic failure. Milionis HJ, Rizos E, Liamis G, Nikas S, Siamopoulos KC, Elisaf MS: Acid-base and electrolyte disturbances in patients with hypercalcemia. The reported prevalence of ICU hypophosphatemia ranges from 10–80%, with a … Miner Electrolyte Metab 1990, 16: 365-368. In addition, timing of onset and duration of hypophosphatemia were … 10.1136/thx.41.8.635, Sankaran RT, Mattana J, Pollack S, Bhat P, Ahuja T, Patel A, Singhal PC: Laboratory abnormalities in patients with bacterial pneumonia. Because of the current paucity of evidence, serum phosphate levels are not routinely measured in all critically ill patients. Surgery 1992, 111: 281-286. J Clin Invest 1978, 62: 1240-1246. In the general hospital population, the prevalence of moderate hypophosphatemia ranges between 2.2 and 3.1% [31, 32], and the prevalence of severe hypophosphatemia is reported to be 0.2 to 0.4% [32–34]. Intravenous therapy is generally recommended in symptomatic hypophosphatemia and phosphate levels <0.32 mmol/L. 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. This is particularly true for major surgery, such as cardiac surgery and abdominal aortic surgery. Google Scholar. 10.1016/j.amjmed.2005.11.026, Article  The consequences of hypophosphatemia for critically ill patients remain controversial. Am J Med 1998, 104: 40-47. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Presse Med. In a review of clinical studies done on hypophosphatemia in pediatric intensive care unit (PICU) patients, its prevalence exceeded 50% [2]. Whether correction of hypophosphatemia reduces mortality is currently unknown. Wang, L., Xiao, C., Chen, L. et al. One should keep in mind that active vitamin D is required for intestinal absorption of phosphate. 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). Therefore, the detection of phosphate metabolism abnormalities in Intensive Care Unit (ICU) populations is crucial. Anesth Analg. 2010;14(4):R147. Finally, patients with diabetic ketoacidosis commonly present with hypophosphatemia due to increased urinary phosphate excretion. Thorax 1986, 41: 635-640. Phosphate serves a number of crucial functions. Murer H, Hernando N, Forster I, Biber J: Proximal tubular phosphate reabsorption: molecular mechanisms. Salem RR, Tray K: Hepatic resection-related hypophosphatemia is of renal origin as manifested by isolated hyperphosphaturia. J Am Coll Surg. Notably, articles on chronic hypophosphatemia (for example, hereditary hypophosphatemic syndromes) were excluded. Results were limited to articles in the English language and to articles on humans. Therapies instituted in the ICU, including overly aggressive renal replacement therapy 3 and erythropoietin therapy, 4 can increase the risk of hypophosphatemia. Decreased intestinal absorption of phosphate rarely causes hypophosphatemia, as a low-phosphate diet increases renal reabsorption and enhances intestinal uptake of phosphate. Liver Transpl 2003, 9: 248-253. After the adjustments for confounding factors, Marcus Broman [15] found that when compared with normal phosphate group, patients with hypophosphatemia episodes had higher risk of death (HR = 1.2, 98.3% CI = 1.0–1.5, P = .0089). California Privacy Statement, 1984;107(4):796–8. 10.1378/chest.83.3.504, Woodhead MA, Macfarlane JT: Legionnaires' disease: a review of 79 community acquired cases in Nottingham. DAG searched the literature, interpreted the results, and drafted the manuscript. Conclusions: Refeeding hypophosphatemia occurs commonly in critically ill patients in the ICU. Phosphate serves a number of crucial functions. 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. 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. Anaesthesia 1998, 53: 895-902. However, they defined hypophosphatemia as phosphate levels < 0.7 mmol/L and no phosphate levels > mmol/L during the ICU stay. An additional preventive strategy is to build up the caloric intake slowly [22]. The cohort included 946 patients with a median phosphate concentration of 0.77 mmol/L (interquartile range 0.55–1.03 mmol/L). Chest 1995, 107: 1698-1701. 2016;352(3):317–23. Am J Med 1992, 92: 458-464. By using this website, you agree to our 2000;18(4):457–61. Few studies have been carried out to investigate the association between the serum phosphorus levels at admission and the outcomes of general ICU population. As showed in Table 2, one hundred and thirty-three of 946 (14.1%) patients got RRT. Anaesthesia 1999, 54: 198. Evidence-based guidelines are needed to guide critical care physicians in the diagnosis and treatment of hypophosphatemia. Chest 1997, 111: 595-600. 10.1136/jnnp.74.6.820, Falcone N, Compagnoni A, Meschini C, Perrone C, Nappo A: Central pontine myelinolysis induced by hypophosphatemia following Wernicke's encephalopathy. CX X, L C, QY K and XF Z carried out the data collection, data analysis, and revised the paper. Brown KA, Dickerson RN, Morgan LM, Alexander KH, Minard G, Brown RO: A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support. 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 … Eur J Cardiothorac Surg 2004, 26: 306-310. Fiaccadori E, Coffrini E, Fracchia C, Rampulla C, Montagna T, Borghetti A. Hypophosphatemia and phosphorus depletion in respiratory and peripheral muscles of patients with respiratory failure due to COPD. The reference range of phosphate was 0.80–1.60 mmol/L. These potential deleterious effects are reversed by phosphate supplementation. PubMed Google Scholar. 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. George R, Shiu MH: Hypophosphatemia after major hepatic resection. In addition, hypophosphatemia has also been associated with decreased tissue oxygenation after correction for 2,3-DPG levels [41]. 81% increase in prolonged respiratory failure requiring tracheostomy [(OR) = 1.81; 95% CI 1.07-3.08] 9. Objective. Br Med J 1969, 1: 753-756. Phosphate is a vital component of the lipid bilayer in the cell membrane, which has essential functions in many biological processes, such as adenosine triphosphate production, glycolysis, pH buffering, 2,3-diphosphoglycerate (2,3-DPG) synthesis, mitochondrial functions, enzyme regulation, signal transduction, and nucleotide metabolism [1,2,3]. Nonetheless, whether hypophosphatemia is associated with mortality in the general ICU patients is still debatable. 10.1016/S0953-6205(02)00130-9, Jacob HS, Amsden T: Acute hemolytic anemia with rigid red cells in hypophosphatemia. More rapid administration of large potassium phosphate boluses is effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function if baseline serum potassium is below 4 mmol/l. South Med J 1987, 80: 831-835. Clin Nephrol 1988, 30: 141-145. Lentz RD, Brown DM, Kjellstrand CM: Treatment of severe hypophosphatemia. Treatment of hypophosphatemia in the intensive care unit: a review. Phosphate depletion causes impaired energy metabolism in the myocardium, leading to decreased contractility [42, 43]. The association of different laboratory parameters with ICU 28-day mortality is presented in Table 3. 10.1016/j.jamcollsurg.2003.09.013, Charron T, Bernard F, Skrobik Y, Simoneau N, Gagnon N, Leblanc M: Intravenous phosphate in the intensive care unit: more aggressive repletion regimens for moderate and severe hypophosphatemia. Incidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. We speculated that hypophosphatemia would have an unfavorable impact on ICU 28-day mortality and can be a marker of disease severity. Further research is needed to establish further the role of this drug in the treatment of hypophosphatemia in critically ill patients. We performed a narrative review of the medical literature to identify the incidence, symptoms, and treatment of hypophosphatemia in critically ill patients. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Hypophosphatemia promotes lower rates of muscle ATP synthesis. All authors reviewed the results and approved the final version of the manuscript. 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). Treatment of hypophosphatemia in the intensive care unit: a review. Treatment consists of phosphate supplementation. Some important limitations to our study should be acknowledged. Hypophosphatemia after cardiac surgery was associated with higher requirements of inotropic support [12]. Specifically, we searched for answers to the questions whether correction of hypophosphatemia is associated with improved outcome, and whether a certain treatment strategy is superior. Typical oral supplementation amounts are three times the normal daily intake, with advised amounts of 2.5 to 3.5 g (80 to 110 mmol) per day, divided over two to three doses. In a review of clinical studies done on hypophosphatemia in pediatric intensive care unit (PICU) patients, its prevalence exceeded 50% [2]. Treatment Increase phosphate intake. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. Neurological involvement in a case of hypophosphatemia. 2004. pp. 81% Hypophosphatemia can lead to myocardial dysfunction and arrhythmias. HYPOPhosphatemia in the Intensive Care: A One-day Point Prevalence Survey (HYPO-P-ICU) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Berger MM, Rothen C, Cavadini C, Chiolero RL: Exudative mineral losses after serious burns: a clue to the alterations of magnesium and phosphate metabolism. Medications and nutritional support were similar between the two groups. Springer Nature. Blood Press 1996, 5: 27-31. After major hepatic surgery, hypophosphatemia is extremely frequent. 2015;10(8):e0133426. Whether maintenance of normal plasma phosphate level and correction of the hypophosphatemia in critically -ill-patients can improve outcome is currently unknown. Patients with hypophosphatemia had a higher ICU 28-day mortality than the normal control group (33.3% vs 24.0%, P < 0.05). Background: Hypophosphatemia is a disorder with potential complications and is often unrecognized in critically ill patients. Daniël A Geerse. South Med J 2002, 95: 1280-1287. A retrospective study was conducted by Yi Yang [17] on patients who had developed hypophosphatemia during the CVVH therapy period. Continuous variables are expressed as mean and SD or median with interquartile range, depending on the underlying data distribution. 15 Hypophosphatemia and Hyperphosphatemia Colin Bauer, Anahat Dhillon Phosphate Homeostasis Derangements in the metabolism of phosphate are common in the intensive care unit (ICU) and can be clinically significant. Pesta DH, Tsirigotis DN, Befroy DE, Daniel C, Jurczak MJ, Yasmeen R, Cline GW, Sylvie D, Birkenfeld AL, Rothman DL. Riedler GF, Scheitlin WA: Hypophosphataemia in septicaemia: higher incidence in gram-negative than in gram-positive infections. Duration of invasive mechanical ventilation. The data for the 28-day mortality in ICU was confirmed by telephone follow-up and inspection of the electronic medical data. Although multiple studies have evaluated the efficacy and safety of phosphate repletion regimens, the effect on mortality and morbidity is not well reported. However, on multivariable logistic regression analysis, hypophosphatemia was not independently associated with ICU mortality (adjusted odds ratio, 0.86 [95% confidence interval, 0.66-1.10]; P = .24) and hospital mortality (odds ratio, 0.89 [0.73-1.07]; P = .21). Abstract Background. Correction of hypophosphatemia, when encountered, is not reported in epidemiologic studies and the spontaneous course of serum phosphate levels without treatment is generally not addressed. The Cochrane Library was also searched for current trials on hypophosphatemia, which yielded no results. Depletion of 2,3- diphosphoglycerate (2,3-DPG) shifts the oxygen dissociation curve to the left, decreasing oxygen delivery to peripheral tissue [39, 40]. Hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure, and is associated with higher mortality. BMC Anesthesiology 10.3171/jns.2001.94.5.0697, Troyanov S, Geadah D, Ghannoum M, Cardinal J, Leblanc M: Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy. 2017. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Aims: To identify the prevalence of hypophosphatemia and risk factors associated to this disorder in critically ill children. Phosphorus is a source of ATP (adenosine triphosphate) required for neurologic functions and muscular contraction. In: Seminars in Dialysis: 2007; 2007: 295–301. Effect of hypophosphatemia on myocardial performance in man. Surgery [ 12 ] prognostic parameter in sepsis patients [ 10,,. Require high-flux dialysis for intoxications are especially at risk should be refed slowly and... Evidence, serum phosphate concentration < 2.5 mg/dl ( 0.81 mmol/L ) 65.3 % were.. 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