scholarly journals Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
John R. Koethe ◽  
Meridith Blevins ◽  
Christopher K. Nyirenda ◽  
Edmond K. Kabagambe ◽  
Janelle M. Chiasera ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Cellular Metabolism ◽  
Serum Phosphate ◽  
Early Mortality ◽  
Serum Phosphate Level ◽  
Similar Relationship ◽  
Refeeding Syndrome ◽  
Art Initiation ◽  
Low Body Mass Index ◽  
Pretreatment Serum

Background. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART.Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality.Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L). Among the 145 participants with BMI<18.5 kg/m2, 28 (19%) died within 12 weeks. Lower pretreatment serum phosphate was associated with increased mortality (odds ratio (OR) 1.24 per 0.1 mmol/L decrement, 95% CI: 1.05 to 1.47;P=0.01) after adjusting for sex, age, and CD4+lymphocyte count. A similar relationship was not observed among participants with BMI ≥18.5 kg/m2(OR 0.96, 95% CI: 0.76 to 1.21;P=0.74).Conclusions. The association of low pretreatment serum phosphate level and early ART mortality among undernourished individuals may represent a variant of the refeeding syndrome. Further studies of cellular metabolism in this population are needed.

scholarly journals The Diagnostic Criteria of Refeeding Syndrome in Critically Ill Patients from four Chinese Hospitals: A Multicenter Prospective Study

2021 ◽  
Author(s):  
Kongmiao Lu ◽  
Xuping Shen ◽  
Xiangxin Zheng ◽  
Xin Xu ◽  
Zhijun Xu ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Phosphate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Serum Phosphate Level ◽  
Refeeding Syndrome ◽  
Group 3 ◽  
Group 2

Abstract Background: Refeeding syndrome (RFS) is a group of metabolic disorders associated with refeeding after starvation. However, the diagnostic criteria of RFS are highly heterogeneous. This study aimed to identify the best diagnostic criteria of RFS in critically ill patients.Methods: A multicenter, parallel, prospective trial enrolled patients (≥18 years) with mechanical ventilation for more than 3 days. RFS, defined as new-onset hypophosphatemia (<0.87mmol/L) within 72h after feeding and a decreased concentration of serum phosphate of more than 30%, from four hospital ICU of Zhejiang provinces in China. The primary endpoint was the 28-day mortality. Results: Between May 1, 2019 and April 30, 2020, 312 patients were enrolled. Of these, 302 patients were included and completed the trial. Except for APACHE II, there were no significant differences in age, gender, admission type, diagnosis, furosemide application, and hormone application. In the RFS2 and RFS3 groups, the APACHE II score was significantly higher than the non-RFS group (p=0.009 and p=0.01, respectively). In the nutritional baseline data, there were no significant differences between the groups in the PNI index, time to start of nutrition treatment, percentage of start nutrition within 48 hours, parenteral nutrition, feeding intolerance, and caloric intake and protein intake within first week. The NRS2002 score in group 2 and 3 was higher than the non-RFS group (p<0.001 and p=0.001, respectively). Moreover, the BMI index in group 3 was lower than the non-RFS group(p=0.001). Furthermore, the 28-day mortality increased in group 2 compared with the non-RFS group. The length of hospital stay in group 3 was significantly longer than that in the non-RFS group (p=0.008). More importantly, according to the preliminary RFS2 screening criteria, patients were further divided into patients with modified RFS and modified non-RFS. The nosocomial infection rate and 28- or 90-day mortality in the modified RFS group were higher than those of the modified non-RFS group (p=0.006 and p=0.02, respectively).Conclusions: The optimal criterion of RFS was a decrease in serum phosphate level of 0.65mmol/L and below, and a reduction of greater than 0.16 mmol/L within 72 h after starting nutritional support. Trial registration: ClinicalTrials.gov database, NCT04005300. Registered 1 July 2019, https://clinicaltrials.gov/ct2/show/ NCT04005300

scholarly journals Evaluation of the Refeeding Syndrome Criteria in Critically Ill Patients in a Chinese Hospital: A Retrospective Study

2020 ◽  
Author(s):  
kongmiao lu ◽  
xiangxin zheng ◽  
huqiang wan ◽  
qiangwen wang ◽  
wei han ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Caloric Intake ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Refeeding Syndrome ◽  
Significant Difference ◽  
Group 2 ◽  
Outcome Duration

Abstract Background: Refeeding syndrome (RFS) was a group of metabolic disorders associated with refeeding after starvation. However, RFS is underdiagnosed in China due to the highly heterogeneous diagnostic criteria. This study was to evaluate the diagnosis of RFS in our intensive care unit (ICU).Methods: Patients monitoring serum phosphate and accepting nutritional treatment more than 3 days were included in our retrospective study. RFS was defined as the new onset hypophosphatemia (<0.87mmol/l) within 72 h after feeding and serum phosphate concentration decreased more than the extent 30%. According to the lowest serum phosphate level within the first 3 days after feeding, all RFS patients were divided into the three groups: Group 1(between 0.65 and 0.87mmol/L as well as more than 30% decrease from baseline), Group 2 (between 0.32 and 0.65mmol/L as well as at least 0.16mmol/L decrease from baseline ) and Group 3 (lower than 0.32mmol/L). The nutritional and prognostic indices were recorded and analyzed within the three groups.Results: A total of 1678 patients were included, of which 150(8.7%) were regularly monitored for serum phosphate. Among these 150 patients, 27 patients were diagnosed the RFS finally. Except for NRS 2002, there were no significant difference in nutritional index such as BMI, percentage of High-risk RFS, total caloric intake, baseline of potassium, magnesium, phosphate and calcium and time to start feeding among three groups. Also, there were no significant differences in clinical outcome, duration of mechanical ventilation and LOS of ICU and hospital. The NRS2002 scores of the three groups were 0.75±0.957, 3.00±1.541 and 4.50±1.049 respectively, and the higher the decline of serum phosphate, the higher the NRS2002 score was (P=0.001). Conclusions: The refeeding hypophosphatemia incidence was not rare in intensive care unit，even serum phosphate has not been monitored regularly. The higher score of NRS2002 might be correlated with greater decline of serum phosphate. However, changes in serum phosphate may be unrelated to prognosis and not be an optimal indicator of low calorie feeding.Trial registration: ClinicalTrials.gov database, NCT04005300. Registered 1 July 2019, https://clinicaltrials.gov/ct2/show/ NCT04005300

scholarly journals Low serum phosphate is not diagnostic for refeeding syndrome in critical care

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
N Venugopal ◽  
P Turner ◽  
R Kolamunnage-Dono ◽  
C Downey ◽  
ID Welters
Keyword(s):  
Critical Care ◽  
Serum Phosphate ◽  
Refeeding Syndrome ◽  
Low Serum

scholarly journals Risk Estimation of Aortic Stiffness in Patients with End Stage Renal Disease on Maintenance Haemodialysis

2019 ◽  
Vol 9 (1) ◽  
pp. 59-62
Author(s):  
Muhammad Abdur Razzak ◽  
Debasish Kumar Saha ◽  
Muhammad Ehsan Jalil ◽  
Mohammad Omar Faruque Miah ◽  
Abu Noim Md Abdul Hai ◽  
...  
Keyword(s):  
Renal Disease ◽  
Serum Calcium ◽  
End Stage Renal Disease ◽  
Aortic Stiffness ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Maintenance Haemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: The stiffness of the large elastic arteries increase the morbidity and mortality. The purpose of the present study was to estimate the risk of aortic stiffness among end stage renal disease patients on maintenance haemodialysis. Methods: This cross-sectional study was carried out in the Department of Nephrology at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh from January 2013 to December 2014 for a period of two years. Chronic kidney disease in stage 5 [CKD-5(D)] patients older than 18 years on maintenance haemodialysis (MHD) for more than 3 months were designated as case group and age and sex matched non CKD patients were considered as control group. Serum calcium, serum albumin, serum phosphate and iPTH were estimated by semi-automated biochemistry analyzer from the Department of Biochemistry of NIKDU, Dhaka and NICVD, Dhaka. Plain Xray abdomen in lateral view was performed for all patients. Result: A total number of 100 patients were enrolled for this study of which 50 patients were in end stage renal disease (ESRD) group and the rest 50 patients were in non-CKD group. Mean (±SD) aortic stiffness index was significantly higher (P<0.001) among ESRD population (3.27±1.70) compared to non CKD group of population (2.00±0.73). Mean (±SD) serum calcium (corrected) level was significantly high (P<0.001) in ESRD patients (9.79±0.87) compared to non CKD group of population (9.13±0.70). Mean (±SD) serum phosphate level was significantly higher (P<0.001) in ESRD patients (5.71±0.96) compared to non CKD group of population (4.20±0.59). However, mean (±SD) iPTH level showed no significant difference between ESRD (25.33±51.98) and non CKD group of population (38.53±19.52). Conclusion: In conclusion, aortic stiffness is significantly higher among ESRD subjects. Birdem Med J 2019; 9(1): 59-62

A teenage girl with low body mass index due to restricting food intake

2021 ◽  
pp. 181-188
Author(s):  
Kathryn S. Czepiel
Keyword(s):  
Body Weight ◽  
Vital Signs ◽  
Primary Treatment ◽  
Evidence Based ◽  
Teenage Girl ◽  
Refeeding Syndrome ◽  
Intense Fear ◽  
Low Body Mass Index ◽  
Family Based ◽  
Evidence Based Psychotherapy

Anorexia nervosa (AN) is an eating disorder that is characterized by restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in the way one’s body weight or shape is experienced. Because many patients with AN attempt to conceal their efforts to lose weight and minimize their symptoms, obtaining information from a caregiver is an important part of the assessment. A medical history and physical examination must be completed to assess medical stability, including review of vital signs, electrocardiogram, and laboratory studies. Medically unstable patients require a medical admission for refeeding and stabilization, including monitoring for refeeding syndrome. Pharmacotherapy should not be used as the primary treatment for patients with AN. The most evidence-based psychotherapy approach for children and adolescents is family-based treatment (Maudsley family therapy).

scholarly journals An Alternative Approach to Treatment of Hypophosphatemia in Nonsurgical Critically Ill Patients in Countries With Limited Resources

Dose-Response ◽  
2019 ◽  
Vol 17 (2) ◽  
pp. 155932581985042
Author(s):  
Tijana Kovačević ◽  
Peđja Kovačević ◽  
Boris Tomić ◽  
Saša Dragić ◽  
Danica Momčičević
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Phosphate Buffer ◽  
Dose Range ◽  
Clinical Status ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Alternative Approach ◽  
Medical Intensive Care ◽  
A Prospective Study

Background: Hypophosphatemia can complicate and prolong the treatment of critically ill patients, and it is even thought to be related to mortality rate. Objectives: The aim of this study is to determine whether using extemporary prepared phosphate buffer in pharmacy would help correct serum phosphate in critically ill patients. Methods: A prospective study was conducted at the medical intensive care unit over a period of 1 year and included 50 patients who were diagnosed with hypophosphatemia. Phosphate buffer was prepared at the pharmacy, and the dose range was recommended by a clinical pharmacist. Results: Patients were administered phosphate buffer via the nasogastric tube, and the doses chosen by the physicians depended on serum phosphate level and the severity of the patients’ clinical status. Serum phosphate levels were successfully corrected in all treated patients. The most frequently used dose was 60 mmoL/d, and in most patients 1-day therapy was sufficient. No adverse effects were observed. Conclusion: The phosphate buffer is an adequate alternative for the treatment of hypophosphatemia of nonsurgically critically ill patients. One-day therapy with the 60 mmoL phosphate dose divided into 3 single doses resulted in normalization of serum phosphate values in most patients.

scholarly journals Varying Effects of APOE Alleles on Extreme Longevity in European Ethnicities

2019 ◽  
Vol 74 (Supplement_1) ◽  
pp. S45-S51 ◽  
Author(s):  
Anastasia Gurinovich ◽  
Stacy L Andersen ◽  
Annibale Puca ◽  
Gil Atzmon ◽  
Nir Barzilai ◽  
...  
Keyword(s):  
United States ◽  
Protective Effect ◽  
Cognitive Aging ◽  
Odds Ratio ◽  
The United States ◽  
Early Mortality ◽  
Genetic Ancestry ◽  
Large Group ◽  
Extreme Longevity ◽  
E4 Allele

Abstract APOE is a well-studied gene with multiple effects on aging and longevity. The gene has three alleles: e2, e3, and e4, whose frequencies vary by ethnicity. While the e2 is associated with healthy cognitive aging, the e4 allele is associated with Alzheimer’s disease and early mortality and therefore its prevalence among people with extreme longevity (EL) is low. Using the PopCluster algorithm, we identified several ethnically different clusters in which the effect of the e2 and e4 alleles on EL changed substantially. For example, PopCluster discovered a large group of 1,309 subjects enriched of Southern Italian genetic ancestry with weaker protective effect of e2 (odds ratio [OR] = 1.27, p = .14) and weaker damaging effect of e4 (OR = 0.82, p = .31) on the phenotype of EL compared to other European ethnicities. Further analysis of this cluster suggests that the odds for EL in carriers of the e4 allele with Southern Italian genetic ancestry differ depending on whether they live in the United States (OR = 0.29, p = .009) or Italy (OR = 1.21, p = .38). PopCluster also found clusters enriched of subjects with Danish ancestry with varying effect of e2 on EL. The country of residence (Denmark or United States) appears to change the odds for EL in the e2 carriers.

scholarly journals P1529MORTALITY PREDICTORS IN INCIDENT HEMODIALYSIS PATIENTS - HAVE HEY CHANGED IN TEN YEARS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Cátia Raquel Figueiredo ◽  
Rachele Escoli ◽  
Hernâni Gonçalves ◽  
Karina Lopes ◽  
Flora Sofia ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Demographic Data ◽  
Venous Catheter ◽  
Early Mortality ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Causes Of Mortality ◽  
Mortality Predictors

Abstract Background and Aims In the last years there has been an increase in elderly patients with multiple comorbidities inducing hemodialysis (HD). Since dialysis treatment itself may be associated with a further deterioration in functional status, nephrologists are increasingly careful in selecting these patients for HD. Concerned with this reality we tried to understood if early mortality predictors (in the first 6 months) in incident HD patients have changed in almost 10 years, in the same hospital HD unit. Method This is a retrospective observational study of incident HD patients between 01 January 2017 and 30 June 2019. We evaluated similar clinical, analytical and demographic data to those used to predict mortality in the same HD unit from 1 January 2010 to 30 September 2014. Logistic regression analysis was used to evaluate 6 month mortality predictors. Statistical analysis was performed using SPSS version 25 for Windows. Results The average age of 163 incident HD patients were 70.63±3.9 years (similar to the previous population: n= 235; 70.7 ± 14.9 years) and 57.1% were male. During this study we observed 26 (16%) deaths, 12 of which (46.15%) occurred in the first 6 months of hemodialysis. Pneumonia and cachexia were the major causes of mortality, unlike the previous population, in which majority of deaths were attributed to cardiovascular events. Between January 2010 to 30 September 2014 the strongest predictors of early mortality were dementia [adjusted odds ratio (OR) 15.94 (CI: 4.09–62.10)], central venous catheter use [(OR) 12.29; (CI: 3.54-42.65)], cancer [(OR) 4.64 (CI: 1.48-14.54)] and heart failure [(OR) 3.57 (CI: 1.08-11.75)]. Differently, in this study, the institutionalization and the presence of metastases were the predictors that showed a higher risk of death [p=0.005; adjusted odds ratio [(OR) 10.4 (CI: 2.017–49.9) and p=0.01; (OR): 14.9 (CI: 1.89-42), respectively]. Longer hospitalizations at the time of HD induction [(p=0.044; (OR):1.103; CI: 1.003-1.213)] and albumin values &lt;2.5 mg/dL [(p=0.03; (OR): 3.8 (CI: 1.14-13)] were also strong mortality predictors. which were not previously observed. Conclusion Nowadays, nephrologists are less liberal in initiating dialysis to elderly patients with dementia and cardiovascular comorbidities. However, the population is getting older and our recent mortality predictors may reflect the aging of chronic kidney disease patients, who have multiple comorbidities as cachexia, requiring institutionalization and longer hospitalizations. It is increasingly important to evaluate patients prior to dialysis initiation, so our goal is to create an adjusted mortality score in our HD unit to help make the decision about inducing or not HD in our patients.

Effects of serum phosphate level on formation of incisor dentine in hypophosphatemic mice

1996 ◽  
Vol 25 (4) ◽  
pp. 182-187 ◽  
Author(s):  
Y. Masatomi ◽  
Y. Nakagawa ◽  
Y. Kanamoto ◽  
S. Sobue ◽  
T. Ooshima
Keyword(s):  
Serum Phosphate ◽  
Phosphate Level ◽  
Serum Phosphate Level

Prognostic value of serum phosphate level in adult patients resuscitated from cardiac arrest

Resuscitation ◽  
2018 ◽  
Vol 128 ◽  
pp. 56-62 ◽  
Author(s):  
Yong Hun Jung ◽  
Byung Kook Lee ◽  
Kyung Woon Jeung ◽  
Chun Song Youn ◽  
Dong Hun Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Value ◽  
Serum Phosphate ◽  
Adult Patients ◽  
Phosphate Level ◽  
Serum Phosphate Level
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