Frequency of hypophosphatemia in critically ill children: risk factors and outcome

Authors

  • Uroosa Saman Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan
  • Asma Noreen Department of Pediatrics, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan
  • Mohammad T. Jamil Department of Pediatrics, Peshawar Institute of Cardiology, Pakistan
  • Muhammad Khalid Department of Pediatrics, Nishtar Medical University, Multan, Punjab, Pakistan
  • Sidra Haq Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan
  • Anwarul Haque Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan

DOI:

https://doi.org/10.18203/2349-3291.ijcp20220757

Keywords:

Hypophosphatemia, Critically ill children, Risk factors, Outcome

Abstract

Background: Phosphorus plays a vital role in maintaining metabolism and energy of body. The objective of this study was to determine the frequency, risk factors and outcome of hypophosphatemia (HP) in critically ill children admitted in pediatric intensive care unit.

Methods: This retrospective study included all critically-ill children having phosphate levels within 24 hours of admission from July 2019 to December 2020. Demographic, clinical and laboratory variables were collected.  HP is defined as serum phosphorus level ≤4 mg/dl in this study. Descriptive statistics along with logistic regression analysis have been reported. 

Results: Prevalence of HP was 53.7% (94/175). Median age was 2 year (0.5-15) and male were 58.5% (106). Serum magnesium level [2.2 (1.5-12.1) vs. 1.8 (1.2-4.0) mg/dl] and serum calcium level [8.7 (.18-10.7) 8.0 (1.8-14.0) mg/dl] were significantly low in the HP group as compared to the normo-phosphatemic group.  There was no significant association of hypo-phosphataemia with admitting diagnosis, ICU therapies, and medications on univariate analysis. Hypo-phosphataemia at admission had no effect on mortality. On multivariate analysis, only male gender demonstrated independent association with HP (OR: 2.2; 95% CI 1.2-4.1; p<0.01).

Conclusions: HP is common in critically ill children and is significantly associated with male gender.  Prospective, larger sample size studies are needed to study the prevalence and risk factors of HP at pediatric intensive care units.

Author Biographies

Uroosa Saman, Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan

Professor of Pediatrics

Head, Pediatric Intensive Care Unit

Department of Pediatrics

Liaquat National Hospital & Medical college, Karachi

Asma Noreen, Department of Pediatrics, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan

Resident of Pediatrics

Department of Pediatrics

Mohammad T. Jamil, Department of Pediatrics, Peshawar Institute of Cardiology, Pakistan

Assistant Professor

Department of Pediatrics

Muhammad Khalid, Department of Pediatrics, Nishtar Medical University, Multan, Punjab, Pakistan

Assistant Professor /Consultant Pediatric Cardiac Intensivist

Sidra Haq, Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan

Assitant Professor

Department of Pediatrics

Anwarul Haque, Department of Pediatrics, Liaquat National Hospital and Medical College, Karachi, Sindh, Pakistan

Resident in Department of Pediatrics

References

Leung J, Crook M. Disorders of phosphate metabolism. J Clin Pathol. 2019;72(11):741-7.

Santana e Meneses JF, Leite HP, de Carvalho WB, Lopes E, Jr. Hypophosphatemia in critically ill children: prevalence and associated risk factors. Pediatr Crit Care Med. 2009;10(2):234-8.

Shah SK, Irshad M, Gupta N, Kabra SK, Lodha R. Hypophosphatemia in critically ill children: risk factors, outcome and mechanism. Indian J Pediatr. 2016;83(12-13):1379-85.

Kilic O, Demirkol D, Ucsel R, Citak A, Karabocuoglu M. Hypophosphatemia and its clinical implications in critically ill children: a retrospective study. J Crit Care. 2012;27(5):474-9.

Leite HP, Pinheiro Nogueira LA, Teodosio AH. Incidence and clinical outcome of hypophosphatemia in pediatric burn patients. J Burn Care Res. 2017;38(2):78-84.

Amanzadeh J, Reilly RF, Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nature Clin Practice Nephrol. 2006;2(3):136-48.

De Menezes FS, Leite HP, Fernandez J, Benzecry SG, de Carvalho WB. Hypophosphatemia in critically ill children. Revista do Hospital das Clin. 2004;59(5):306-11.

Alla DGAM, Khater N, Rahman DA, Abd A. Factors involved in predisposing children with critical illness to eventually develop hypophosphatemia. Eur J Mol Clin Med. 2021;8(4):405-14.

El Shazly AN, Soliman DR, Assar EH, Behiry EG, Ahmed IAENG. Phosphate disturbance in critically ill children: Incidence, associated risk factors and clinical outcomes. Ann Med Surg. 2017;21:118-23.

Leite HP, Pinheiro Nogueira LA, Teodosio AHC. Incidence and clinical outcome of hypophosphatemia in pediatric burn patients. J Burn Care Res 2017;38(2):78-84.

Bugg NC, Jones JA. Hypophosphataemia. Pathophysiology, effects and management on the intensive care unit. Anaesthesia. 1998;53(9):895-902.

Springer AMdM, Hortencio TDR, Melro EC, de Souza TH, Nogueira RJN. Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition. J Parenteral Enteral Nutrition. 2021.

Nia KS, Motazedi Z, Mahmoudi L, Ahmadi F, Ghafarzad A, Jafari-Rouhi AH. Hypophosphatemia in critically ill children. J Res Clin Med. 2016;4(3):153-7.

Rady HI, Khalek M. Prevalence and risk factors of hypophosphatemia in pediatric intensive care unit. J Anesth Crit Care Open Access. 2014;1(6):25-6.

Shankar P, Guda SR. Hypophosphataemia in critically ill children. J Evol Med Dental Sci. 2016;5(53):3480-3.

Abouamer A, Soliman D, Shaban H, Anter NJBJoAS. Calcium, Magnesium and phosphate deficiency and their Effect on Clinical outcome in Critically Ill child. Ben J App Sci. 2020;5(2 part (2)):317-22.

El Beleidy A, El Sherbini SA, Elgebaly HF, Ahmed A. Calcium, magnesium and phosphorus deficiency in critically ill children. Egyp Pediatr Asso Gazette. 2017;65(2):60-4.

De Menezes FS, Leite HP, Fernandez J, Benzecry SG, de Carvalho WB. Hypophosphatemia in children hospitalized within an intensive care unit. J Intensive Care Med. 2006;21(4):235-9.

Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care. 2010;14(4):1-8.

Loudenot A, Michot C, Alberti C, Armoogum P, Tsapis M, Dauger S. High prevalence of hypophosphataemia at PICU admission in non-malnourished children. Intensive Care Med. 2010;36(8):1443.

Downloads

Published

2022-03-24

Issue

Section

Original Research Articles