Refeeding Syndrome in the First Seventy-Two Hours: Risk Stratification and the Limits of Phosphate Monitoring
DOI:
https://doi.org/10.5281/zenodo.22275627Keywords:
Refeeding syndrome, Hypophosphataemia, Risk stratification, Parenteral nutrition, ElectrolytesAbstract
Refeeding syndrome is anticipated by stratifying patients before feeding starts and monitoring phosphate afterwards. Neither step
performs as well as its use implies. In a cohort of 149 patients receiving parenteral nutrition, the proportion developing refeeding
hypophosphataemia was between 23 and 48 per cent depending only on which diagnostic criterion was applied, and the guideline
risk criteria discriminated poorly across all of them, with areas under the curve of 0.43 to 0.53. A model built from critical illness,
diuretic use and pre-existing hypomagnesaemia reached 0.74 but awaits validation. A randomised trial in intensive care found no
difference in electrolyte decrement, corrected QT abnormality, infection or length of stay between moderate-risk and high-risk
groups. The consensus definition requires falls in phosphorus, potassium or magnesium and describes its own severity thresholds
as arbitrary. What is supported by randomised evidence is calorie restriction once hypophosphataemia appears.
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