High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function.
OBJECTIVE
To determine the incidence of hypophosphatemia in a surgical intensive care unit and to determine whether or not a phosphorus challenge causes a change in cardiac performance in hypophosphatemic patients.


METHODS
Prospective clinical study and case reports.


METHODS
Surgical intensive care unit in an university hospital.


METHODS
A total of 208 consecutive patients admitted to the surgical ICU were evaluated over a 6 months period.


METHODS
All classical risk factors for hypophosphatemia were recorded. A group of 8 moderate or severe hypophosphatemic patients were evaluated for hemodynamic data before and after a phosphorus load. Glucose phosphate was given over 30 min by the intravenous route. Dosage regimen was 0.4 mmol/kg weight for moderate hypophosphatemia and 0.8 mmol/kg weight for severe hypophosphatemia.


RESULTS
Risk factors were present in 134 patients and 60 patients were hypophosphatemic (44.8%). Only 3 risk factors were discriminant for hypophosphatemia: sepsis, diuretics and total parenteral nutrition. The mortality was higher in the hypophosphatemic group than in the normophosphatemic group (30% versus 15.2%; p < 0.05). Cardiac performance improved after phosphatemia normalization in all patients (cardiac index: 3.82 +/- 1.87 versus 4.52 +/- 1.83 1/min.m2; p < 0.01).


CONCLUSIONS
This study underlines the high incidence (28.8%) of hypophosphatemia in surgical intensive care patients and its association with a high mortality rate (30%). A short course of phosphotherapy improves cardiac index (+18%).
Zazzo
J F
JF
Department of Anesthesiology, Université paris-Sud, Hôpital Antoine Béclère, Clamart, France.
Troché
G
G
Ruel
P
P
Maintenant
J
J
D000368:Aged; D002302:Cardiac Output / Q000187:drug effects*; D016002:Discriminant Analysis; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors
D010758:Phosphorus