Frequency and Risk Factors Associated with Hypophosphatemia in Critically Ill Children
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Background: Hypophosphatemia is a clinically important electrolyte disturbance in critically ill children and may affect respiratory, cardiac, neuromuscular, hematological, and metabolic function. Objective: To determine the frequency of hypophosphatemia and assess selected clinical and treatment-related factors associated with hypophosphatemia among critically ill children admitted to a pediatric intensive care unit. Methods: This descriptive observational study with comparative association analysis was conducted in the Pediatric Medicine Department, Intensive Care Unit, Children Hospital, Multan, from December 2024 to May 2025. A total of 160 children aged 2 months to 12 years were enrolled by non-probability consecutive sampling. Hypophosphatemia was defined as serum phosphorus <3.8 mg/dL in children younger than 2 years and <3.5 mg/dL in children aged 2 years or older, using the lowest documented phosphate level during intensive care stay. Data were analyzed using SPSS version 23. Results: The mean age was 4.61 ± 3.21 years, and 92 (57.5%) children were male. Hypophosphatemia was observed in 112 (70.0%) children. Malnutrition, acute kidney injury, steroid use, furosemide use, and beta-2 agonist therapy were significantly associated with hypophosphatemia. Children with hypophosphatemia had longer hospital stay than those with normal phosphate levels, 9.00 ± 4.10 versus 6.10 ± 2.70 days, p<0.001, and higher mortality, 31.3% versus 14.6%, p=0.046. Conclusion: Hypophosphatemia was frequent among critically ill children and was associated with malnutrition, acute kidney injury, and selected medication exposures. Routine phosphate monitoring should be considered in high-risk pediatric intensive care patients.
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