Clinical nutrition ESPEN · 2025
Moderate-severe hypophosphatemia, hypomagnesemia, and hypokalemia disturbances in critically ill patients receiving total parenteral nutrition therapy.
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Russo Hortencio Taís Daiene, Springer Alice Missagia de Mattos, Silveira Leonardo Rezende, Golucci Ana Paula Brigatto Simões, Filho Roberto Mauro Savioli, Nogueira Roberto José Negrão
Аннотация
BACKGROUND & AIMS: Moderate-severe hypophosphatemia (M-SHypoP), moderate-severe hypokalemia (M-SHypoK), and moderate-severe hypomagnesemia (M-SHypoM) are prevalent mineral disturbances in critically ill patients, particularly in the ICU setting. Despite their clinical significance, these disturbances have received limited attention in recent medical literature. This study aimed to investigate their prevalence in critically ill adult ICU patients receiving total parenteral nutrition (PN) compared with non-ICU patients receiving total PN.
METHODS: A historical retrospective cohort analysis was conducted using prospectively collected data from a quaternary hospital over an 8-year period. A total of 736 patients, older than 19 years and receiving PN, were included. Nutritional status (body weight and height) was assessed before starting nutritional support. Serum concentrations of phosphorus, potassium, and magnesium were evaluated within the first 7 days after initiating PN infusion.
RESULTS: Out of 736 patients included in the study, 545 (74 %) were admitted to the ICU. ICU patients had higher rates of surgical procedures (P = 0.009), and mortality (P = 0.001). Laboratory monitoring revealed common phosphorus imbalance in ICU patients, particularly during the first 4 days after PN infusion. ICU participants developed more M-SHypoP when compared to non-ICU (P = 0.002).
CONCLUSION: Prompt detection and treatment of mineral imbalances in ICU patients are crucial. Critically ill patients admitted to ICUs are at a heightened risk of developing hypophosphatemia compared to those not in the ICU. Thus, there is a potential necessity to introduce a novel PN regimen tailored for hypercatabolic patients within the initial 3 days of PN initiation in the ICU.
METHODS: A historical retrospective cohort analysis was conducted using prospectively collected data from a quaternary hospital over an 8-year period. A total of 736 patients, older than 19 years and receiving PN, were included. Nutritional status (body weight and height) was assessed before starting nutritional support. Serum concentrations of phosphorus, potassium, and magnesium were evaluated within the first 7 days after initiating PN infusion.
RESULTS: Out of 736 patients included in the study, 545 (74 %) were admitted to the ICU. ICU patients had higher rates of surgical procedures (P = 0.009), and mortality (P = 0.001). Laboratory monitoring revealed common phosphorus imbalance in ICU patients, particularly during the first 4 days after PN infusion. ICU participants developed more M-SHypoP when compared to non-ICU (P = 0.002).
CONCLUSION: Prompt detection and treatment of mineral imbalances in ICU patients are crucial. Critically ill patients admitted to ICUs are at a heightened risk of developing hypophosphatemia compared to those not in the ICU. Thus, there is a potential necessity to introduce a novel PN regimen tailored for hypercatabolic patients within the initial 3 days of PN initiation in the ICU.