Hypophosphatemia and associated risk factors on the pediatric intensive care Unit

The rate of hypophosphatemia during hospitalization is 1-5%, while it is by 80% for patients being monitored in intensive care units. The higher incidence rate in intensive care units is due to many risk factors that predispose to development of hypophosphatemia in these patients. Although hypophosphatemia is seen frequently, its diagnosis may not always be obvious because clinical signs are usually occured in severe hypophosphatemia (< 1 mg/dl). Clinical symptoms are associated with the decrease in the level of intracellular concentrations of adenosine triphosphate and 2,3 diphosphoglycerate which leads to acute respiratory failure, cardiomyopathy, osteomalacia, rhabdomyolysis, and hemolysis. Inadequate contraction of diaphragm may impede successful weaning from mechanical ventilation. This study was carried out prospectively on the patients who were hospitalized on the pediatric intensive care unit of Gaziantep University between december 2013 to june 2014.The phosphorus levels were recorded on the first day of hospitalization and for ten days of follow up. PRISM (pediatric risk of mortality), P-MODS (pediatric multiple organ dysfunction score), PELOD (pediatric logistic organ dysfunction) scores were recorded for every patient.; The duration of mechanic ventilation and hospitalization on intensive care, staying time on hospital and mechanical ventilation receiving, weight z scores,risk factors, feeding with TPN or enteral nutririon were recorded. The frequency of hypophosphatemia was found as 28.1% during admission, 66,7 % at day 3. hypophosphataemia was seen %89,7 of the patients who can be observed for 7 days. For all following periods hypophosphatemia was seen on 46 of 57 patients (%80,7). İn the comparison of the patients who were hypophosphatemic and non hypophosphtemic on admission and following period; there was no statistically difference on ages, weight z scores, PELOD, MODS and PRİSM scores, mechanical ventilation receiving rate and mechanical ventilation time. There was a positive correlation between the presence of hypophhosphatemia and time of intensive care vii duration. Hypophosphatemia seen higher on the patients who had malignant solid tumors on admission. Both on admission and following period hypophosphatemia seen more in girls than boys. Hypophosphatemia seen more on the patient who took TPN. Hypophosphatemia seen more on the patients who had higher fibrinogen levels on admission. As a result, hypophosphatemia is more commonly seen in patients with malignant solid tumors and girls and prolongs the length of stay in intensive care. Evaluation of hypophosphatemia and associated factors in pediatric intensive care units in larger prospective studies is required.