title: Hypophosphatemia in Enterally Fed Patients in the Surgical Intensive Care Unit.
abstract: BACKGROUND
  Hypophosphatemia has been associated with refeeding malnourished patients, but its clinical significance is unclear. We investigated the incidence of refeeding hypophosphatemia (RH) in the surgical intensive care unit (SICU) and its association with early enteral nutrition (EN) administration and clinical outcomes.
  
  
  METHODS
  We performed a retrospective review of a 2-year database of patients receiving EN in the SICU. RH was defined as a post-EN phosphorus (PHOS) level decrement of >0.5 mg/dL to a nadir <2.0 mg/dL within 8 days from EN initiation. We investigated the risk factors for RH and examined its association with clinical outcomes using multivariable regression analyses.
  
  
  RESULTS
  In total, 213 patients comprised our analytic cohort. Eighty-three of 213 (39%) individuals experienced RH and 43 of 130 (33%) of the remaining patients experienced non-RH hypophosphatemia (nadir PHOS level <2.0 mg/dL). Overall, there was a total 59% incidence of hypophosphatemia of any cause (N = 126). Nutrition parameters did not differ between groups; most patients were initiated on EN within 48 hours of SICU admission, and timing of EN initiation was not a significant predictor for the development of RH. The median hospital length of stay (LOS) was 21 and 24 days for those with and without RH, respectively ( P = .79); RH remained a nonsignificant predictor for hospital LOS in the multivariable analysis.
  
  
  CONCLUSIONS
  RH is common in the SICU but is not related to timing or amount of EN. Hypophosphatemia is also common in the critically ill, but regardless of etiology, it was not found to be a predictor of worse clinical outcomes.
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Eva
authors: E
authors: Fuentes
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: D Dante
authors: DD
authors: Yeh
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Sadeq A
authors: SA
authors: Quraishi
authors: 2 Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Emily A
authors: EA
authors: Johnson
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Haytham
authors: H
authors: Kaafarani
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Jarone
authors: J
authors: Lee
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: David R
authors: DR
authors: King
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Marc
authors: M
authors: DeMoya
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Peter
authors: P
authors: Fagenholz
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Kathryn
authors: K
authors: Butler
authors: 3 Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Yuchiao
authors: Y
authors: Chang
authors: 1 Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: George
authors: G
authors: Velmahos
mesh_terms: D000368:Aged; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010710:Phosphates / Q000097:blood; D055677:Refeeding Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010710:Phosphates
keywords: enteral nutrition; hypophosphatemia; refeeding syndrome