Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 30; no. 3; pp. 365 - 368
• Main Authors: Zeki, Sebastian, Culkin, Alison, Gabe, Simon M, Nightingale, Jeremy M
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.06.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Enteral feeding; Enteral Nutrition - adverse effects; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Humans; Hypophosphataemia; Hypophosphatemia - epidemiology; Hypophosphatemia - etiology; Incidence; Intubation, Gastrointestinal; Medical Records; Middle Aged; National Health Programs; Parenteral feeding; Parenteral Nutrition - adverse effects; Phosphates - blood; Practice Guidelines as Topic; Refeeding syndrome; Refeeding Syndrome - blood; Refeeding Syndrome - epidemiology; Refeeding Syndrome - mortality; Refeeding Syndrome - physiopathology; Retrospective Studies; Risk Factors; Sensitivity and Specificity; United Kingdom - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Water-Electrolyte Imbalance - etiology; Young Adult; Parenteral feeding; Hypophosphataemia; Refeeding syndrome; Enteral feeding; Human; Hydroelectrolytic balance disorder; Metabolic disorder; Refeeding; Adult; Hypophosphatemia; Metabolic diseases; Phosphorus; Inorganic element; Enteral administration; Parenteral administration; Feeding
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2010.12.001

Summary Background & aims Refeedinghypophosphataemia (RH) can result in sudden death. This study aimed to compare the incidence of RH between patients fed enterally and those fed parenterally. Methods The risk of RH in adult patients fed parenterally (PN) or nasogastrically (NG) was assessed by comparison of patient records with the UK NICE guidelines for refeeding syndrome, between December 2007 and December 2008. A fall in serum phosphate to less than 0.6 mmol/L was indicative of RH. Results Of 321 patients,92 were at risk of RH. Of these, 23 (25%) patients developed RH ( p  = 0.003). 18 (33%) of NG fed, ‘at-risk’ patients developed RH vs 5 (13%) fed parenterally ( p  = 0.03). Death within 7 days and RH were not associated. The sensitivity and specificity of the NICE criteria for defining patient’s risk of RH was calculated: 0.76 and 0.50 respectively for NG feeding; 0.73 and 0.38 respectively for parenteral feeding. Conclusion Patients fed by NG tube and deemed at risk of RH are more likely to develop RH than patients fed by PN. The higher risk with NG feeding may be due to the incretin effect from absorption of glucose. The UK guidelines lack specificity.