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Nutritional hypophosphatemic rickets secondary to Neocate® use

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Abstract

Elemental formula is commonly used in children with feeding intolerance. We describe two, medically complex and feeding tube dependent, patients exclusively fed with Neocate® who subsequently developed hypophosphatemic rickets. Both patients had gross motor decline and pain with physical touch. They were found to have low serum phosphorus, normal calcium, and vitamin D studies, with elevated alkaline phosphatase suggestive of nutritional hypophosphatemia. Both courses were complicated by hypocalcemia following formula change and phosphorus supplementation, highlighting the need for careful management of phosphate repletion in affected individuals. Diligent serial electrolyte monitoring as well as attention to bone health is needed in conjunction with elemental nutrition. Formula change led to restoration of calcium and phosphorus homeostasis and radiographic improvement in these patients.

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Fig. 1
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Abbreviations

GI:

Gastrointestinal

FDA:

Food and Drug Administration

GERD:

Gastroesophageal reflux disease

G-Tube:

Gastrostomy tube

ALP:

Alkaline phosphatase

TRP:

Tubular reabsorption of phosphate

EoE:

Eosinophilic esophagitis

SFED:

Six food elimination diet

IV:

Intravenous

PPI:

Proton pump inhibitors

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Author information

Authors and Affiliations

  1. Center For Endocrinology, Diabetes and Metabolism, Division of Pediatrics, Children’s Hospital Los Angeles (CHLA), 4650 Sunset Blvd, # 61, Los Angeles, CA, 90027, USA

    S. Akhtar Ali & P. Pitukcheewanont

  2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    A. Mathalikunnel

  3. Division of Gastroenterology, Hepatology and Nutrition, CHLA, Los Angeles, CA, USA

    V. Bhardwaj

  4. Division of Clinical Immunology and Allergy, CHLA, Los Angeles, CA, USA

    M. Braskett

Authors
  1. S. Akhtar Ali
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  2. A. Mathalikunnel
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  3. V. Bhardwaj
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  4. M. Braskett
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  5. P. Pitukcheewanont
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Correspondence to P. Pitukcheewanont.

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Table of Contents Summary: We describe two patients exclusively fed with Neocate® who developed hypophosphatemic rickets. Both courses were complicated by hypocalcemia following intervention, highlighting the need for careful management in affected individuals.

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Akhtar Ali, S., Mathalikunnel, A., Bhardwaj, V. et al. Nutritional hypophosphatemic rickets secondary to Neocate® use. Osteoporos Int 30, 1887–1891 (2019). https://doi.org/10.1007/s00198-019-04836-8

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  • DOI: https://doi.org/10.1007/s00198-019-04836-8

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