Hypophosphatemia among severely malnourished children with sepsis in Bangladesh

Abstract

Background: The interaction between hypophosphatemia (HP) and severe malnutrition has received little attention. This study investigated the prevalence, severity, and risk factors of HP among severely malnourished children with sepsis in Bangladesh.

Methods: Children aged 6-59 months admitted with sepsis to Dhaka Hospital from April 2010 to December 2011 were enrolled in the study and divided into two groups: severe acute malnutrition (SAM) and non-SAM groups. Plasma phosphate and the related biochemical parameters were measured upon admission and on the second and fourth days for both groups and the 10th day or discharge day for the SAM group.

Results: The prevalence of HP (plasma phosphate <3.7 mg/dL) was 72.9% and 62.5% (P = 0.26) for 48 SAM and for 56 non-SAM patients, respectively; that of moderate-severe HP (phosphate <2 mg/dL) was 25.0% and 19.6%, respectively (P = 0.51). The plasma phosphate level of 21 SAM patients was significantly lower on the second and fourth days than upon admission (P = 0.03, P = 0.01, respectively); it then recovered on the 10th day or discharge day. On multiple logistic regression analysis, plasma potassium <2.5 mmol/L upon admission was found to be a risk factor for moderate or severe HP (adjusted odds ratio, 7.21; 95% confidence interval: 1.88-27.7).

Conclusion: HP is common among children with sepsis. Potassium <2.5 mmol/L upon admission is considered a risk factor for moderate or severe HP in children with sepsis.