Nutritional hypophosphatemic rickets secondary to Neocate® use

Elemental formula is commonly used in children with feeding intolerance. We describe two, medically complex and feeding tube dependent, patients exclusively fed with Neocate® who subsequently developed hypophosphatemic rickets. Both patients had gross motor decline and pain with physical touch. They...

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Bibliographic Details
Published in:Osteoporosis international 2019-09, Vol.30 (9), p.1887-1891
Main Authors: Akhtar Ali, S., Mathalikunnel, A., Bhardwaj, V., Braskett, M., Pitukcheewanont, P.
Format: Article
Language:English
Subjects:
Alkaline phosphatase
Amino Acids - adverse effects
Calcium homeostasis
Carbohydrates - adverse effects
Case Report
Child, Preschool
Dietary Fats - adverse effects
Dietary supplements
Endocrinology
Feeding
Food, Formulated - adverse effects
Homeostasis
Humans
Hypocalcemia
Hypophosphatemia
Intolerance
Male
Medicine
Medicine & Public Health
Orthopedics
Pain
Phosphorus
Radiography
Rheumatology
Rickets
Rickets, Hypophosphatemic - diagnostic imaging
Rickets, Hypophosphatemic - etiology
Vitamin D
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Summary:Elemental formula is commonly used in children with feeding intolerance. We describe two, medically complex and feeding tube dependent, patients exclusively fed with Neocate® who subsequently developed hypophosphatemic rickets. Both patients had gross motor decline and pain with physical touch. They were found to have low serum phosphorus, normal calcium, and vitamin D studies, with elevated alkaline phosphatase suggestive of nutritional hypophosphatemia. Both courses were complicated by hypocalcemia following formula change and phosphorus supplementation, highlighting the need for careful management of phosphate repletion in affected individuals. Diligent serial electrolyte monitoring as well as attention to bone health is needed in conjunction with elemental nutrition. Formula change led to restoration of calcium and phosphorus homeostasis and radiographic improvement in these patients.
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-019-04836-8