Introduction Critical illness may trigger an acute phase response which is associated with several metabolic derangements. These include hypo- and hypercalcemia, hypo- and hyperphosphatemia, hypo- and hypomagnesaemia. Method Therefore, we conducted a prospective, non-interventional study in 10 beds intensive care unit of the at Pediatric Intensive Care Unit, Cairo University Pediatric Hospital. During 6 months period to investigate the incidence & risk factors of magnesium, phosphorus & calcium deficiency in patients admitted to the intensive care unit (ICU) on admission and followed the course of deficiency at day 3 & ten during stay. Results Out of 70 patients, the frequency of Calcium deficiency was (34%), magnesium deficiency (31%), phosphorus deficiency (47%) on admission. Calcium and magnesium deficiency frequency changed gradually after 72 h & 10 days; in response to intravenous supplementation for deficient patients. While phosphorus level declined during follow up. Respiratory failure (87%) was the most common organ failure followed by neurological failure. Patients with hypocalcaemia on admission had a higher PELOD score (P = 0.10), coagulopathy (P = 0.044), sepsis diagnoses (P = 0.007), metabolic acidosis (P = 0.001), hyperglycemia (P = 0.006) hypomagnesaemia (P = 0.001), hypoalbuminemia (P = 0.004). While hypomagnesaemia risk factors were coagulopathy (P = 0.039), inborn error of metabolism (P = 0.039), sepsis diagnoses (P = 0.045), hypocalcaemia (P = 0.001), hypophosphatemia (P = 0.004), hypoalbuminemia (P = 0.042). Hypophosphatemia was associated with hypokalemia (P = 0.003) & hypomagnesaemia (P = 0.004). Regression analysis revealed metabolic acidosis & hyperglycemia were associated with calcium deficiency, while inborn error of metabolism and hypophosphatemia with magnesium deficiency. Risk factors for Hypophosphatemia are hypokalemia & hypomagnesaemia. Conclusion Hypophosphatemia was the most frequent and under estimated electrolyte disturbance in our study.
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