This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Prospective Study

Paul E. Marik, MD; Mary Kay Bedigian, MS, RD, CNSD

Arch Surg. 1996;131(10):1043-1047.

Abstract
Background
Hypophosphatemia has been reported after refeeding of malnourished patients. Nutritional support is often delayed in patients in the intensive care unit (ICU) as a consequence of enteral intolerance and bowel hypomotility.

Objective
To determine the incidence, risk factors, and clinical impact of refeeding hypophosphatemia in a heterogeneous group of patients in an ICU.

Design
Prospective, noninterventional study.

Settings
Surgical and medical ICUs of a university-affiliated community hospital.

Patients
Sixty-two patients in the ICU who were refed after being starved for at least 48 hours were prospectively followed up.

Interventions
None.

Main Outcome Measures
Each patient had a nutritional assessment prior to the initiation of nutritional support. Serum phosphate, magnesium, and calcium levels were measured at baseline, and these measurements were repeated daily. Refeeding hypophosphatemia was considered to have developed in patients whose serum phosphorus level fell by more than 0.16 mmol/L to below 0.65 mmol/L.

Results
Twenty-one patients (34%) experienced refeeding hypophosphatemia. In 6 patients, the serum phosphorus level fell below 0.32 mmol/L. The only risk factor studied that could predict the development of hypophosphatemia was the serum prealbumin concentration (mean ± SD, 127±34vs79±40 g/L;P<.001). Seventeen (81%) of these 21 patients in whom hypophosphatemia developed had a prealbumin concentration less than 110 g/L compared with that in 12 (30%) of the patients who did not experience this complication (P<.001). In those patients in whom refeeding hypophosphatemia developed, the serum phosphorus level reached a mean ± SD nadir of 1.9 ± 1.1 days after feeding was started. Although the Acute Physiology and Chronic Health Evaluation II score was similar (mean± SD, 19±6 vs 18±7), the length of mechanical ventilation (mean±SD, 10.5±5.2vs7.1±2.8 days; P=.04) and the length of hospital stay (mean±SD, 12.1±7.1 vs 8.2±4.6 days; P=.01) were significantly longer in those patients who experienced hypophosphatemia compared with those patients who did not experience this complication.

Conclusions
Refeeding hypophosphatemia occurs commonly in critically ill patients in the ICU. Starvation for a period as short as 48 hours and poor nutritional status predispose to this syndrome. Patients at risk should be refed slowly, and the serum phosphorus level should be closely monitored and supplemented as required.

Arch Surg.
1996;131:1043-1047

Author Affiliations
From the Departments of Critical Care Medicine (Dr Marik) and Nutrition and Food Services (Ms Bedigian), St Vincent Hospital, and University of Massachusetts, Worcester.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Refeeding syndrome: what it is, and how to prevent and treat it
Mehanna et al.
BMJ 2008;336:1495-1498.
FULL TEXT  

Too Much Too Soon? Refeeding Syndrome as an Iatrogenic Cause of Delirium
Caplan
Psychosomatics 2008;49:249-251.
ABSTRACT | FULL TEXT  

Death Resulting From Overzealous Total Parenteral Nutrition: The Refeeding Syndrome Revisited
Miller
Nutr Clin Pract 2008;23:166-171.
ABSTRACT | FULL TEXT  

Hypophosphatemia: Clinical Consequences and Management
Brunelli and Goldfarb
J. Am. Soc. Nephrol. 2007;18:1999-2003.
ABSTRACT | FULL TEXT  

Assessing Nutritional Status in Chronically Critically Ill Adult Patients
Higgins et al.
Am J Crit Care 2006;15:166-176.
ABSTRACT | FULL TEXT  

Refeeding Syndrome and Hypophosphatemia
Marinella
J Intensive Care Med 2005;20:155-159.
ABSTRACT  

Editorial: Refeeding Syndrome and Hypophosphatemia
Khardori
J Intensive Care Med 2005;20:174-175.
 

Assessing the Metabolic and Clinical Consequences of Early Enteral Feeding in the Malnourished Patient
Flesher et al.
JPEN J Parenter Enteral Nutr 2005;29:108-117.
ABSTRACT | FULL TEXT  

Defining and Assessing Tolerance in Enteral Nutrition
Bernard et al.
Nutr Clin Pract 2004;19:481-486.
ABSTRACT | FULL TEXT  

Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients
American Society for Parenteral and Enteral Nutrit
JPEN J Parenter Enteral Nutr 2002;26:1SA-138SA.
 

Enteral and Parenteral Electrolyte Therapeutics
Baumgartner
Nutr Clin Pract 2001;16:226-232.
 

A Comparison of Renal Phosphorus Regulation in Thermally Injured and Multiple Trauma Patients Receiving Specialized Nutrition Support
Dickerson et al.
JPEN J Parenter Enteral Nutr 2001;25:152-159.
ABSTRACT  

Editorial: Monitoring and Replacing Minerals and Vitamins in Critical Illness
Helton
Nutr Clin Pract 2000;15:117-119.
 

Acute Nutrition Interventions Help Identify Indicators of Quality in a Trauma Service
Klein and Henry
Nutr Clin Pract 1999;14:85-91.
ABSTRACT  

The Clinical Implications of Hypophosphatemia Following Major Hepatic Resection or Cryosurgery
Buell et al.
Arch Surg 1998;133:757-761.
ABSTRACT | FULL TEXT