Authors: Pooja Gautam , Deepak Gupta , Rohan Acharya , Kanika Agarwal , Ankush Gautam

Abstract

Background: Hypophosphatemia is a recognized complication during the treatment of severe acute malnutrition (SAM) in children and may contribute to refeeding syndrome. Data on the longitudinal profile of serum phosphate using locally prepared WHO-recommended therapeutic feeds in India remain limited.

Objective: To describe serum phosphate dynamics and the incidence and correlates of hypophosphatemia in children aged 6-59 months hospitalized with complicated SAM.

Methods: A prospective observational study was conducted from January to December 2024 at a tertiary paediatric department in north India.

Results: Sixty children (6-59 months) with SAM (WHZ/L <-3 SD, MUAC <11.5 cm, and/or bilateral oedema) and medical complications were enrolled. Serum inorganic phosphate, sodium, potassium, and calcium were measured at admission, day 4 (end of stabilization phase), and at discharge (only if hypophosphatemia persisted on day 4).  Median (IQR) serum phosphate was 3.81 (0.20) mg/dL. By day 4, the prevalence decreased significantly to 8/60 (13.3%; p=0.001), and at discharge no child remained hypophosphatemic (0%). Mean serum phosphate rose from 3.68 ± 0.49 mg/dL at admission to 4.02 ± 0.13 mg/dL at discharge (p<0.001).

Conclusion: Hypophosphatemia is common at admission (38.3%) in children with complicated SAM but resolves effectively with standard WHO-protocol stabilization using locally prepared F-75 formula without additional phosphate supplementation. Hypophosphatemia is strongly linked to concurrent disturbances in sodium, potassium, and calcium, highlighting the importance of holistic electrolyte monitoring during early refeeding.

Keywords: f-75, hypophosphatemia, MUAC, refeeding syndrome, severe acute malnutrition.