title: Hypophosphatemia, Hypomagnesemia, and Hypokalemia in Pediatric Patients Before and During Exclusive Individualized Parenteral Nutrition.
abstract: BACKGROUND
  Hypophosphatemia, hypomagnesemia, and hypokalemia occur in patients receiving parenteral nutrition (PN), mainly when the body's stores are depleted due to fasting or inflammation. Although these disorders are potentially fatal, few studies have reported the incidence in the pediatric population.
  
  
  METHODS
  This study evaluated, in a historical cohort of pediatric patients, the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia until 48 hours before initiation of PN infusion (P1) and from days 1-4 (P2) and days 5-7 (P3) of PN infusion and investigated if malnutrition, calories, and protein infusion were correlated to these disorders.
  
  
  RESULTS
  Malnutrition was present in 32.8% (n = 119) of the subjects; 66.4% of the patients were in the pediatric intensive care unit. Survival rate was 86.6%. P1 had the highest prevalence of mineral disorders, with 54 events (58.1%; P2, n = 35, 37.6%; P3, n = 4, 4.3%). Hypokalemia events were related to malnutrition (odds ratio, 2.79; 95% confidence interval, 1.09-7.14; P = .045). In the first 7 days, infused calories were below the amount recommended by current guidelines in up to 84.9% of patients, and protein infused was adequate in up to 75.7%. Protein infused above the recommendation in the first 4 days was related to hypomagnesaemia (odds ratio, 5.66; 95% confidence interval, 1.24-25.79; P = .033).
  
  
  CONCLUSIONS
  Hypophosphatemia, hypokalemia, and hypomagnesemia were frequent in hospitalized pediatric patients before and during the first 4 days of PN infusion. Patients with malnutrition had more chances of having hypokalemia, and those who received high protein infusion had an increased chance of developing hypomagnesemia.
authors: Department of Pediatrics, State University of Campinas, Unicamp, Brazil taisdaiene@gmail.com.
authors: Taís Daiene Russo
authors: TD
authors: Hortencio
authors: Department of Pediatrics, State University of Campinas, Unicamp, Brazil.
authors: Roberto José Negrao
authors: RJ
authors: Nogueira
authors: Department of Pediatrics, State University of Campinas, Unicamp, Brazil Department of Medical Genetics, State University of Campinas, Unicamp, Brazil.
authors: Fernando Augusto
authors: FA
authors: de Lima Marson
authors: Department of Pediatrics, State University of Campinas, Unicamp, Brazil.
authors: Antonio Fernando
authors: AF
authors: Ribeiro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D007008:Hypokalemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D017674:Hypophosphatemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008275:Magnesium Deficiency / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects*; D015995:Prevalence; D055815:Young Adult
chemical_list: D018977:Micronutrients
keywords: hypokalemia; hypomagnesemia; hypophosphatemia; parenteral nutrition; pediatrics; refeeding syndrome