Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients.
OBJECTIVE
Refeeding hypophosphataemia (RH) can result in sudden death. This study aimed to compare the incidence of RH between patients fed enterally and those fed parenterally.


METHODS
The risk of RH in adult patients fed parenterally (PN) or nasogastrically (NG) was assessed by comparison of patient records with the UK NICE guidelines for refeeding syndrome, between December 2007 and December 2008. A fall in serum phosphate to less than 0.6 mmol/L was indicative of RH.


RESULTS
Of 321 patients,92 were at risk of RH. Of these, 23 (25%) patients developed RH (p = 0.003). 18 (33%) of NG fed, 'at-risk' patients developed RH vs 5 (13%) fed parenterally (p = 0.03). Death within 7 days and RH were not associated. The sensitivity and specificity of the NICE criteria for defining patient's risk of RH was calculated: 0.76 and 0.50 respectively for NG feeding; 0.73 and 0.38 respectively for parenteral feeding.


CONCLUSIONS
Patients fed by NG tube and deemed at risk of RH are more likely to develop RH than patients fed by PN. The higher risk with NG feeding may be due to the incretin effect from absorption of glucose. The UK guidelines lack specificity.
Lennard-Jones Intestinal Failure Unit, St. Mark's hospital, Harrow, Middlesex, UK. sebastiz@hotmail.com
Sebastian
S
Zeki
Alison
A
Culkin
Simon M
SM
Gabe
Jeremy M
JM
Nightingale
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects; D006801:Humans; D017674:Hypophosphatemia / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007441:Intubation, Gastrointestinal; D008499:Medical Records; D008875:Middle Aged; D009313:National Health Programs; D010288:Parenteral Nutrition / Q000009:adverse effects; D010710:Phosphates / Q000097:blood; D017410:Practice Guidelines as Topic; D055677:Refeeding Syndrome / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology; D055815:Young Adult
D010710:Phosphates