{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:44:54Z","timestamp":1791913494469,"version":"4.3.4"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["24CDA1267699"],"award-info":[{"award-number":["24CDA1267699"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL173709-01"],"award-info":[{"award-number":["K23HL173709-01"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1K23HL179517-01"],"award-info":[{"award-number":["1K23HL179517-01"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The JP Bickell Foundation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate hospital-level variation in the supplementation of calcium, magnesium, phosphate, and potassium in critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Premier Healthcare Database of inpatients from the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Adults (age\u2009\u2265\u200918 years) admitted to an intensive care unit (ICU) on hospital day 1 between October 1, 2022 and July 31, 2024, who had at least one calcium (total or ionized), magnesium, phosphate, or potassium level measured in an ICU between day 2 and 28. We excluded patients with renal failure, a pregnancy-related diagnosis, and intracranial bleeding on admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Calcium, magnesium, phosphate, or potassium supplementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Measurements and main results<\/jats:title>\n                    <jats:p>We included 47,988 patients from 67 ICUs across 52 hospitals, totaling 167,621 patient-days with a measurement of one of the studied electrolytes. Median age was 64 years (interquartile range [IQR] 52\u201374) and 46% (22,057) were female. There were 38,621 patients (80.5%) with a minimum value below a lower limit of normal, and 33,626 (70.1%) patients who received supplementation. Across hospitals, the median (IQR) percentages receiving supplementation per day were: calcium 9.4% (6.7\u201312.2); magnesium 28.6% (22.6\u201335.0); phosphate 19.1% (15.9\u201323.2); potassium 28.9% (25.8\u201334.6). From a multilevel model, the median relative odds of supplementation, comparing any two hospitals, ranged from 1.51 (95% confidence interval [CI] 1.48\u20131.55) for potassium to 2.09 (95% CI 1.99\u20132.19) for magnesium. At most hospitals, there were no calcium or phosphate levels at which the percentage receiving supplementation exceeded 50%. At 75% of hospitals there was a magnesium level at which the percentage receiving magnesium supplementation was 50% or more (range: 1.5\u20132.1 mg\/dL), and at 96% of hospitals there was an analogous potassium level (range: 3.3\u20133.9 mmol\/L).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec007\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Supplementation of calcium, magnesium, phosphate, or potassium is common in critically ill patients and varies across hospitals, suggesting a need for randomized trials to clarify optimal supplementation practices.<\/jats:p>\n                  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