Phosphorus abnormalities in a paediatric intensive care unit in North India

Introduction: Critical illness triggers severe acute phase response which is associated with several metabolic derangements. Serum phosphorus level abnormalities are common among them and go unnoticed in sick children.
Objectives: To determine the prevalence of phosphorus abnormalities in sick children admitted to the paediatric intensive care unit (PICU) and its association with various clinical outcomes.
Method: We conducted a prospective, non-interventional study at a PICU in North India. During an 18-month period we investigated the incidence of phosphorus abnormalities in patients admitted to the PICU on admission and followed the course at day 3 and day 7 during their stay.
Results: The prevalence of phosphorus level abnormalities was 44.2% on admission to PICU; 34.9% patients had hypophosphataemia while 9.3% had hyperphosphataemia. Hypophosphataemia was significantly associated with severe malnutrition (p=0.041) while hyperphosphataemia was associated with organ failure (p=<0.001). Although the need for mechanical ventilation, duration of PICU stay and mortality were higher in hypophosphataemic patients and PRISM score was higher in hyperphosphataemic patients, these differences were not statistically significant. Changes in the baseline phosphorus levels after PICU stays of 3 days (p=0.346) and of 7 days (p=0.782) were not statistically significant.
Conclusions: Phosphorus abnormalities were highly prevalent in ill children admitted in the PICU. Hypophosphatemia was more common and was significantly associated with severe malnutrition while hyperphosphatemia was significantly associated with organ failure.