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VOLUME 27 , ISSUE 4 ( April, 2023 ) > List of Articles

Original Article

Frequency and Risk Factors of Hypophosphatemia in Patients Admitted to Emergency Intensive Care Unit in Zagazig University Hospitals

Ahmed El-Sayed Mohamed El-Sayed Bsar, Samia Abdel-Rahman El-Wakiel, Mona Abdel-Hameed El-Harrisi, Amr Shaaban Hafez Elshafei

Keywords : Accidental poisoning, Acute hypoxemic respiratory failure, Adolescent, Cardiac output blood pressure

Citation Information : Bsar AE, El-Wakiel SA, El-Harrisi MA, Elshafei AS. Frequency and Risk Factors of Hypophosphatemia in Patients Admitted to Emergency Intensive Care Unit in Zagazig University Hospitals. Indian J Crit Care Med 2023; 27 (4):277-282.

DOI: 10.5005/jp-journals-10071-24431

License: CC BY-NC 4.0

Published Online: 31-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Inorganic phosphate is a major electrolyte that participates in many functional and integral processes in the human body. Low Pi levels may lead to multiple organ dysfunction. It is estimated to occur in 40–80% of intensive care unit (ICU) patients. However, it may be ignored during the initial evaluation in ICU. Materials and methods: This prospective cross-sectional study included 500 adult ICU cases in two groups; a group with normal Pi levels and a group with hypophosphatemia. All admitted patients were subjected to full history taking, and clinical, laboratory, and radiological evaluation. Collected data were coded, processed, and analyzed using statistical package for social sciences (SPSS) software. Results: Among 500 adult ICU patients; 56.8% had normal phosphate levels while the remaining 43.2% had low phosphate levels. Patients in the hypophosphatemia group were associated with a significantly higher Acute Physiological and Chronic Health Evaluation (APACHE II) score, a longer hospital and ICU stay, a higher incidence of mechanical ventilation use with a longer duration on it, and a significantly higher mortality rate. Conclusion: Risk factors for hypophosphatemia include a higher APACHE II score, longer stay in the hospital and ICU, a higher ratio of mechanical ventilation, and a higher mortality rate.

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  1. Gaasbeek A, Meinders AE. Hypophosphatemia: An update on its etiology and treatment. Am J Med 2005;118(10):1094–1101. DOI: 10.1016/j.amjmed.2005.02.014.
  2. Pontes MH, Groisman EA. Protein synthesis controls phosphate homeostasis. Genes Dev 2018;32(1):79–92. DOI: 10.1101/gad. 309245.117.
  3. Jeffrey YH, Hoi–Ping S, Kit Hung AL, Chung–Ling L, Wing–Wa Y, King–Yiu L. Experiences with continuous venovenous hemofiltration using 18 mmol/L predilution citrate anticoagulation and a phosphate containing replacement solution. Indian J Crit Care Med 2017;21(1): 11–16. DOI: 10.4103/0972-5229.198311.
  4. Subramanian R, Khardori R. Severe hypophosphatemia. Pathophysiologic implications, clinical presentations, and treatment. Medicine (Baltimore). 2000;79(1):1–8. DOI: 10.1097/00005792-200001000-00001.
  5. Forrester SD MK. Hypophosphatemia. Causes and clinical consequences. J Vet Intern Med 1989;3(3):149–159. DOI: 10.1111/j.1939-1676.1989.tb03091.x.
  6. Weisinger JR, Bellorín–Font E. Magnesium and phosphorus. Lancet 1998;352(9125):391–396. DOI: 10.1016/S0140-6736(97)10535-9.
  7. Gaudry S, Hajage D, Schortgen F, Martin–Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375(2):122–133. DOI: 10.1056/NEJMoa1603017.
  8. Polderman KH BF, F W Bloemers, Peerdeman SM, Girbes AR. Hypomagnesemia and hypophosphatemia at admission in patients with severe head injury. Crit Care Med 2000;28(6):2022–2025. DOI: 10.1097/00003246-200006000-00057.
  9. Salem RR, Tray K. Hepatic resection-related hypophosphatemia is of renal origin as manifested by isolated hyperphosphaturia. Ann Surg 2005;241(2):343–348. DOI: 10.1097/01.sla.0000152093.43468.c0.
  10. Shor R, Halabe A, Rishver S, Tilis Y, Matas Z, Fux A, et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci 2006;36(1):67–72. PMID: 16501239.
  11. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, et al. Intensity of continuous renal-replacement therapy in critically ill patients. New Engl J Med 2009;361(17):1627–1638. DOI: 10.1056/NEJMoa0902413.
  12. Reddi AS. Disorders of phosphate: Hypophosphatemia. In: Reddi AS, editor. Fluid, Electrolyte and Acid–Base Disorders, 2nd edition. New York: Springer, 2018, p.259–272.
  13. Falcone N, Compagnoni A, Meschini C, Perrone C, Nappo A. Central pontine myelinolysis induced by hypophosphatemia following Wernicke's encephalopathy. Neurol Sci 2004;24(6):407–410. DOI: 10.1007/s10072-003-0197-9.
  14. Wang L, Xiao C, Chen L, Zhang X, Kou Q. Impact of hypophosphatemia on outcome of patients in intensive care unit: A retrospective cohort study. BMC Anesthesiol 2019;19(1):86. DOI: 10.1186/s12871-019- 0746-2.
  15. Buell JF, Berger AC, Plotkin JS, Kuo PC, Johnson LB. The clinical implications of hypophosphatemia following major hepatic resection or cryosurgery. Arch Surg 1998;133(7):757–761. DOI: 10.1001/archsurg.133.7.757.
  16. Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: A review. Crit Care 2010;14(4):R147. DOI: 10.1186/cc9215.
  17. Felsenfeld AJ, Levine BS. Approach to treatment of hypophosphatemia. Am J Kidney Dis 2012;60(4):655–661. DOI: 10.1053/j.ajkd.2012. 03.024.
  18. Suzuki S, Egi M, Schneider AG, Bellomo R, Hart GK, Hegarty C. Hypophosphatemia in critically ill patients. J Crit Care 2013;28(4):536.e9–536.e19. DOI: 10.1016/j.jcrc.2012.10.011.
  19. Amanzadeh J, Reilly RF Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nature Reviews Nephrology 2006;2(3):136.
  20. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 2005;62(16):1663–1682. DOI: 10.2146/ajhp040300.
  21. Tan SC, Freebairn R. Electrolyte disorders in the critically ill. Anaesth Intensive Care Med 2017;18(3):133–137. DOI: 10.1016/j.mpaic.2016. 11.011.
  22. Hoffmann M, Zemlin A, Meyer W, Erasmus R. Hypophosphataemia at a large academic hospital in South Africa. J Clinic Pathol 2008;61(10):1104–1107. DOI: 10.1136/jcp.2007.054940.
  23. Engwerda E, Van den Berg M, Blans M, Bech A, De Boer H. Efficacy and safety of a phosphate replacement strategy for severe hypophosphatemia in the ICU. Neth J Med 2018;76(10):437–441. PMID: 30569887.
  24. Martinez M, Martinez M, Montero M, Campelo E, Castro I, Inaraja M. Hypophosphatemia in postoperative patients with total parenteral nutrition: Influence of nutritional support teams. Nutr Hosp 2006;21(6):657–660. PMID: 17147062.
  25. Cohen J, Kogan A, Sahar G, Lev S, Vidne B, Singer P. Hypophosphatemia following open heart surgery: Incidence and consequences. Eur J Cardiothorac Surg 2004;26(2):306–310. DOI: 10.1016/j.ejcts. 2004.03.004.
  26. Wadsworth R, Siddiqui S. Phosphate homeostasis in critical care. BJA Educ 2016;16(9):305–309. DOI: 10.1093/bjaed/mkw033.
  27. Betro M, Pain R. Hypophosphataemia and hyperphosphataemia in a hospital population. Br Med J 1972;1(5795):273–276. DOI: 10.1136/bmj.1.5795.273.
  28. Larsson L, Rebel K, Sörbo B. Severe hypophosphatemia: A hospital survey. Acta Medica Scand 1983;214(3):221–223. DOI: 10.1111/j.0954-6820.1983.tb08598.x.
  29. Yaman A. Severe rhabdomyolysis and acute renal failure treated by continuous venovenous hemodiafiltration in a child with diabetic ketoacidosis. Indian J Crit Care Med 2022;26(1):136–138. DOI: 10.5005/jp-journals-10071-24093.
  30. Camp M, Allon M. Severe hypophosphatemia in hospitalized patients. Miner Electrolyte Metab 1990;16(6):365–368. PMID: 2089250.
  31. Marik PE, Bedigian MK. Refeeding hypophosphatemia in critically ill patients in an intensive care unit: A prospective study. Arch Surg 1996;131(10):1043–1047. DOI: 10.1001/archsurg.1996.01430220037007.
  32. Chung PY, Sitrin MD, Te HS. Serum phosphorus levels predict clinical outcome in fulminant hepatic failure. Liver Transpl 2003;9(3):248–253. DOI: 10.1053/jlts.2003.50053.
  33. Vaidyanathan D, Venkatesan S, Ramadesikan VK. Serum phosphate in acute myocardial infarction. Indian J Physiol Pharmacol 2000;44(2):225–228. PMID: 10846641.
  34. Wilson HK, Keuer SP, Lea AS, Boyd AE, Eknoyan G. Phosphate therapy in diabetic ketoacidosis. Arch Internal Med 1982;142(3):517–520. PMID: 6802095.
  35. Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, et al. Hyperphosphatemia is an independent risk factor for mortality in critically ill patients: Results from a cross-sectional study. PloS One 2015;10(8):e0133426. DOI: 10.1371/journal.pone.0133426.
  36. Sin JCK, King L, Ballard E, Llewellyn S, Laupland KB, Tabah A. Hypophosphatemia and outcomes in ICU: A systematic review and meta-analysis. J Intensive Care Med 2021;36(9):1025–1035. DOI: 10.1177/0885066620940274.
  37. Lim C, Tan HK, Kaushik M. Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events. Clin Kidney J 2017;10(3):341–347. DOI: 10.1093/ckj/sfw120.
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