HIGH-INCIDENCE OF HYPOPHOSPHATEMIA IN SURGICAL INTENSIVE-CARE PATIENTS - EFFICACY OF PHOSPHORUS THERAPY ON MYOCARDIAL-FUNCTION

Objective: To determine the incidence of hypophosphatemia in a surgica l intensive care unit and to determine whether or not a phosphorus cha llenge causes a change in cardiac performance in hypophosphatemic pati ents. Design: Prospective clinical study and case reports. Setting: Su rgical intensive care unit in an university hospital. Patients: A tota l of 208 consecutive patients admitted to the surgical ICU were evalua ted over a 6 months period. Interventions: All classical risk factors for hypophosphatemia were recorded. A group of 8 moderate or severe hy pophosphatemic patients were evaluated for hemodynamic data before and after a phosphorus load. Glucose phosphate was given over 30 min by t he intravenous route. Dosage regimen was 0.4 mmol/kg weight for modera te hypophosphatemia and 0.8 mmol/kg weight for severe hypophosphatemia . Results: Risk factors were present in 134 patients and 60 patients w ere hypophosphatemic (44.8%). Only 3 risk factors were discriminant fo r hypophosphatemia: sepsis, diuretics and total parenteral nutrition. The mortality was higher in the hypophosphatemic group than in the nor mophosphatemic group (30% versus 15.2%; p < 0.05). Cardiac performance improved after phosphatemia normalization in all patients (cardiac in dex: 3.82 +/- 1.87 versus 4.52 +/- 1.83 l/min . m(2); p < 0.01). Concl usion: This study underlines the high incidence (28.8%) of hypophospha temia in surgical intensive care patients and its association with a h igh mortality rate (30%). A short course of phosphotherapy improves ca rdiac index (+18%).