Hypophosphatemia in a specialized intestinal failure unit: an observational cohort study

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Background Patients with intestinal failure (IF) are prone to hypophosphatemia and shifts in magnesium and potassium levels. While these shifts are often attributed to refeeding syndrome (RFS), the incidence of electrolyte shifts among patients with IF is unknown. We evaluated the occurrence of hypophosphatemia and other electrolyte shifts according to the functional and pathophysiological IF classifications. Methods We consecutively included all patients’ first admission to an IF unit from 2013 through 2017. Electrolyte shifts were defined as severe hypophosphatemia <0.6 mmol/L (mM) or any two other shifts below normal range, comprising hypomagnesemia <0.75 mM, hypophosphatemia <0.8 mM, or hypokalemia <3.5 mM. Outcomes included length of stay, central line‐associated blood stream infection, and other infections. Mortality was evaluated six months after discharge. Results Of 236 patients with IF, electrolyte shifts occurred in 99 (42%), and 127 (54%) of these patients received intravenous supplementation with either phosphate, magnesium, or potassium. In patients who started parenteral nutrition (PN), up to 62% of early onset shifts (<5 days) related to refeeding, and up to 63% of late onset (≥5 days) could be ascribed to infections. Derangements occurred in 7 (18%) with type 1 IF, 53 (43%) with type 2 IF, and 39 (53%) readmitted patients with type 3 IF. Of 133 patients with IF secondary to short bowel syndrome, 65 (49%) developed shifts. Conclusion In patients with IF, electrolyte shifts are frequent but not always due to RFS. Electrolyte shifts are common in patients with type 2 and those readmitted with type 3 IF.
Original languageEnglish
JournalJournal of Parenteral and Enteral Nutrition
Number of pages9
Publication statusE-pub ahead of print - 2020

    Research areas

  • enteral nutrition, hypophosphatemia, intestinal failure, parenteral nutrition

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