الفهرس 
Chapter (I): Critically Ill ChildrenOnly 14 pages are availabe for public view
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Abstract
Electrolyte disturbances develop frequently in critically ill children during the course of stay in the Pediatric Intensive Care Unit (PICU).
Hypophosphatemia appears a common finding in critically ill children worldwide, but its exact prevalence and relevance to these children remain unclear. First, the definition of hypophosphatemia varies both between studies and between age groups. Hence, an occurrence rate of hypophosphatemia in critically ill children varying from 5% to 76% has been reported, depending on the cut-off value used. Moreover, the consequences of hypophosphatemia remain uncertain, although some studies have reported an association between hypophosphatemia and worse clinical outcome in critically ill children.
Critically ill children are at high risk for developing hypophosphatemia due to the presence of several causative factors, the mechanisms of hypophosphatemia in paediatric intensive care units may be due to decreased absorption, increased renal loss or internal redistribution of inorganic phosphate due to alkalosis and is a life-threatening factor that causing death in children with protein energy malnutrition disorders.
Symptoms of hypophosphatemia tend to be nonspecific in the majority of cases and include fatigue and irritability. Lower level (less than 1.0 mg/dl) may lead to more hypophosphatemia serious problems such as reduced diaphragmatic contractility, cardiac arrhythmias, myocardial reduction and severe congestive cardiac insufficiency.
Hyperphosphatemia occurs in several endocrine conditions associated with increased tubular reabsorption of phosphate. Research revealed that the incidence of hyperphosphatemia was 12% in all patients at admission to a tertiary care hospital.
Hyperphosphatemia is potentially associated with increased morbidity and mortality in the general populations.
Severe and acute hyperphosphatemia can result in hypocalcemia. The latter can result in muscle cramps, arrhythmias, hypotension, and seizures
Phosphate disturbance has been reported to be associated with increased morbidity and mortality in critically ill patients such as respiratory failure, increase the duration of stay on mechanical ventilation, and increased PICU length of stay.
Thus, the aim of our study was to determine the prevalence, clinical picture, and the relation of serum phosphorus abnormalities with outcome of critically ill children.
The present study was prospective observational study, conducted on 90 of critically ill paediatric patients admitted into PICU, Faculty of Medicine, Menoufia University from the age of 1 month to 16 years during the period from October 2020 to April 2022. Serum phosphorus was measured on PICU admission, then repeated on day4, day8, and day 12. Patients were monitored till PICU discharge or death.
The results of this study could be summarized as following:
The most frequent reason for PICU admission was neurological followed by respiratory, then cardiac disorders.
The median age was 36 months (IQR: 5 - 99 m). 57.8% of patients were males. 16.7% of patients had sepsis. 12.2 % had severe sepsis. 28.9% of patients needed mechanical ventilation. The median mechanical ventilation duration was 1.5 days (IQR: 1-3 days). 24.4% of patients died. pSOFA of patients was 2 (IQR: 1-4). PICU stay days was 8 (IQR: 5-15.5). 23.3% of patients received steroids, 10% received diuretics, and 45.6% received omeprazole.
On admission, the frequency of hypophosphatemia was 37.8% while that of hyperphosphatemia was 6.6%. Over the first 12 days of PICU stay, 52.2% of patients had hypophosphatemia while 12.2% had hyperphosphatemia. 22.2% of patients had single episode of phosphorus abnormality while 42.2% had persistant or recurrent abnormalities. Only 2.2% of patients had severe hypophosphatemia and 2.2% had severe hyperphosphatemia.
On admission, the frequency of hypophosphatemia was significantly higher among patients with sepsis/severe sepsis. Serum potassium on admission was significantly lower among patients with hypophosphatemia.
The frequency of steroid intake and hospital acquired infections was significantly higher among patients with hypophosphatemia. PICU stay was significantly longer among patients with hypophosphatemia.
The frequency of sepsis was signifcantly higher among patients with hyperphosphatemia.
The frequency of sepsis, pSOFA, elevated creatinine, and mechanical ventilation were significantly higher among patients with hyperphosphatemia.
The median age was significantly lower among non-survivors compared with survivors and weight was significantly increased among survivors group than non-survivors group. The frequency of shock, mechanical ventilation, and nosocomial infection was significantly higher among non-survivors.
The median pSOFA score was significantly higher among non-survivors. A significantly higher prevalence of sepsis and severe sepsis was found among non-survivors compared with survivors. Vasoactive infusion days were significantly higher among non survivors.
CRP was significantly higher, while serum albumin was significantly lower among non-survivors compared with survivors.