Refeeding syndrome: incidence of refeeding hypophosphatemia and other electrolyte abnormalities among patients referred to Clinical Nutrition Physicians- a report from a private tertiary care hospital in the Philippines
Background: The incidence of hypophosphatemia in relation to refeeding syndrome is well-recognized in other countries. Though there has been no consensus yet as to the exact definition of refeeding syndrome, refeeding hypophosphatemia remains to be a hallmark. In the Philippines, there is no report yet on in-hospital tertiary care hypophosphatemia among those referred to Clinical Nutrition physicians. This study aims to describe the incidence of refeeding hypophosphatemia among patients referred to the Nutrition Service of a private tertiary care hospital in the Philippines.
Methods: A review of medical records was done among patients referred to Clinical Nutrition physicians of St. Luke's Medical Center-Quezon City from January 2013 to September 2014. Descriptive evaluation was done which included nutrition score, weight loss, subjective global assessment score and electrolyte abnormalities.
Results: A total of 30 patients were included for review had low serum phosphorus wthin the first 72 hours of admission and an SGA C grade upon assessment. All patients were noted to have been placed on 20 kcal and above per kg body weight caloric requirement prior to referral. There were 47% underweight patients, 70% had suboptimal intake while 27% had starvation by nutrition history. Majority of the patients had cancer, 11 of which underwent either chemotherapy or radiotherapy and 8 patients underwent major surgery. Of the total 30 patients with hypophosphatemia within the 24-72-hour period of initiation of nutrition support, a total of 9 patients were seen to have an established drop in serum phosphorus levels based on two succeeding blood determination.
Conclusion: Refeeding hypophosphatemia exists in clinical practice and awareness on the risks and complications of refeeding syndrome should be a vital part of nutrition management.