Effect of Intravenous Electrolyte Supplementation on Refeeding Syndrome for Patients Initiated on Parenteral Nutrition

<b>Background:</b> Refeeding syndrome (RS) is a potentially life-threatening condition, marked by decreases in serum phosphorus, potassium, or magnesium, that commonly occurs in patients who receive parenteral nutrition (PN) after a period of inadequate caloric intake. <b>Objective:</b> To compare the occurrence and severity of RS in hospitalized patients who received intravenous (IV) electrolyte supplementation versus those who did not receive IV electrolyte supplementation prior to initiation of PN. <b>Methods:</b> This single-center, retrospective cohort study included adult patients hospitalized over a 10-year period who received PN. The primary outcome was the occurrence of RS in each group (decrease in serum phosphorus, potassium, or magnesium of 10% or more from baseline within 5 days of PN initiation). <b>Results:</b> A total of 124 patients were included in the study, with 62 patients in each group. Fifty-two patients (83.9%) in the IV electrolyte supplementation group developed RS of any severity compared to 48 patients (77.4%) in the no IV electrolyte supplementation group (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 0.62 to 3.74, <i>P</i> = 0.4). The IV electrolyte supplementation group developed more mild cases of RS (OR = 2.48, 95% CI = 1.14 to 5.40, <i>P</i> = 0.02), had a lower median decrease in serum phosphorus (median difference [MD] = -6.0, 95% CI = 10.9 to <-0.1, <i>P</i> = 0.03), and had lower in-hospital mortality (OR = 0.25, 95% CI = 0.09 to 0.74, <i>P</i> = 0.008). There were no significant differences for other secondary outcomes. <b>Conclusion:</b> Overall occurrence of RS was not significantly different between groups. However, some findings were suggestive of benefit associated with IV electrolyte supplementation.