Phosphate Supplementation in Parenteral Nutrition

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Abstract
Pronounced serum phosphate deficiency was shown to be deleterious when starting parenteral nutrition in severely malnourished patients. The consequences of phosphate deficiency and the need for phosphate supplementation in critically ill patients are not well known. ICU [intensive care unit] (30) patients randomized into 2 groups were studied. The patients received complete parenteral nutrition with and without addition of extra phosphate. The low phosphate group got 7.5 mmol phosphate (from the phospholipids in the fat emulsion) and the high phosphate group got 60-80 nmmol phosphate/day. There were no significant differences in serum phosphate or Ca levels between the groups. In the high phosphate group the phosphate balance was positive and Ca balance zero while in the low phosphate group both phosphate and Ca balances were negative. The phosphate content in a standard nutrition program is not sufficient to create a positive phosphate balance. With the addition of 80 mmol phosphate/day a positive balance was achieved. It is hard to establish guidelines for the administration of phosphate in ICU patients, 20-40- mmol may normally be satisfactory but ICU patients may need and can tolerate up to 80 mmol/day.

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