High incidence of hypophosphatemia in surgical intensive care patients : efficacy of phosphorus therapy on myocardial function

• Published in: Intensive care medicine 1995-10, Vol.21 (10), p.826-831
• Main Authors: ZAZZO, J.-F, TROCHE, G, RUEL, P, MAINTENANT, J
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Output - drug effects; Discriminant Analysis; Drug Monitoring; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; Humans; Hypophosphatemia - blood; Hypophosphatemia - drug therapy; Hypophosphatemia - etiology; Hypophosphatemia - mortality; Incidence; Intensive care medicine; Male; Medical sciences; Middle Aged; Phosphorus - blood; Phosphorus - pharmacology; Phosphorus - therapeutic use; Prospective Studies; Risk Factors
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/BF01700966

To determine the incidence of hypophosphatemia in a surgical intensive care unit and to determine whether or not a phosphorus challenge causes a change in cardiac performance in hypophosphatemic patients. Prospective clinical study and case reports. Surgical intensive care unit in an university hospital. A total of 208 consecutive patients admitted to the surgical ICU were evaluated over a 6 months period. All classical risk factors for hypophosphatemia were recorded. A group of 8 moderate or severe hypophosphatemic patients were evaluated for hemodynamic data before and after a phosphorus load. Glucose phosphate was given over 30 min by the intravenous route. Dosage regimen was 0.4 mmol/kg weight for moderate hypophosphatemia and 0.8 mmol/kg weight for severe hypophosphatemia. Risk factors were present in 134 patients and 60 patients were hypophosphatemic (44.8%). Only 3 risk factors were discriminant for hypophosphatemia: sepsis, diuretics and total parenteral nutrition. The mortality was higher in the hypophosphatemic group than in the normophosphatemic group (30% versus 15.2%; p < 0.05). Cardiac performance improved after phosphatemia normalization in all patients (cardiac index: 3.82 +/- 1.87 versus 4.52 +/- 1.83 1/min.m2; p < 0.01). This study underlines the high incidence (28.8%) of hypophosphatemia in surgical intensive care patients and its association with a high mortality rate (30%). A short course of phosphotherapy improves cardiac index (+18%).