A single centre experience of refeeding hypophosphataemia and refeeding syndrome in parenteral nutrition and a proposal for a sub-fulminant categorisation.

BACKGROUND: Refeeding syndrome (RFS) is an uncommon, but potentially serious, complication of nutrition therapy. There remains a lack of consensus as to the clinical definition of RFS and refeeding hypophosphataemia (RH), and what measures should be included to assess risk. This study aims to evaluate the prevalence of RH and RFS using previously proposed criteria in our cohort of patients receiving parenteral nutrition (PN), and assess the National Institute for Health and Care Excellence guidelines as risk factors. METHODS: A single-centre prospective cohort study of adult patients (age ≥18 years) receiving PN for more than 48 h over a 5 year period. Prevalence of RH was determined using four previously established diagnostic criteria and RFS by the King's College criteria. Risk factors were assessed using univariate analysis and multiple logistic regression. RESULTS: 354 cases fulfilled the inclusion criteria. 4.5-13.3% (17-47 of the 354 cases) met at least one of the criteria for RH. No cases met the criteria for RFS. Thirteen (3.7%) cases with RH manifested signs of fluid overload without an alternative explanation except possible refeeding syndrome. Weight loss above 10% over 3-6 months (P = 0.03), serum albumin (P = 0.02), and serum haemoglobin (P = 0.01) were factors associated with RH. CONCLUSION: Prevalence of RH varies considerably according to the established criteria used, but overall remains uncommon. Previously defined RFS was not seen in our cohort of patients. A combination of RH and fluid overload without an alternative cause may represent sub-fulminant RFS.