Refeeding syndrome
| Refeeding syndrome | |
|---|---|
| Specialty | Nutrition  |
Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished.[1] Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described after the Second World War in prisoners of war taken by Japan.[2]
Syndrome
Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. Most effects result from a sudden shift from fat to carbohydrate metabolism and a sudden increase in insulin levels after refeeding which leads to increased cellular uptake of phosphate. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes including phosphate, potassium, magnesium, glucose, and thiamine. Significant risks arising from refeeding syndrome include confusion, coma, convulsions, and death.
This syndrome can occur at the beginning of treatment for anorexia nervosa when patients are reintroduced to a healthy diet. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is also increased which strains the respiratory system and can make weaning from ventilation more difficult.
Treatment
Refeeding syndrome can be fatal if not recognized and treated properly. If potassium, phosphate or magnesium are low then this should be corrected. Prescribing thiamine, vitamin B complex (strong) and a multivitamin and mineral is recommended. Biochemistry should be monitored regularly until it is stable.
References
- ^ Mehanna HM, Moledina J, Travis J (2008). "Refeeding syndrome: what it is, and how to prevent and treat it". BMJ. 336 (7659): 1495–8. doi:10.1136/bmj.a301. PMC 2440847. PMID 18583681.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ SCHNITKER MA, MATTMAN PE, BLISS TL (1951). "A clinical study of malnutrition in Japanese prisoners of war". Ann. Intern. Med. 35 (1): 69–96. PMID 14847450.
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General references
- Shils, M.E., Shike, M., Ross, A.C., Caballero, B. & Cousins, R.J. (2006). Modern nutrition in health and disease, 10th ed. Lippincott, Williams & Wilkins. Baltimore, MD.
- Mahan, L.K. & Escott-Stump, S.E. (2004) Krause’s Food, Nutrition, & Diet Therapy, 11th ed. Saunders, Philadelphia, PA.
- Hearing S (2004). "Refeeding syndrome". BMJ. 328 (7445): 908–9. doi:10.1136/bmj.328.7445.908. PMID 15087326.
- Crook M, Hally V, Panteli J (2001). "The importance of the refeeding syndrome". Nutrition. 17 (7–8): 632–7. doi:10.1016/S0899-9007(01)00542-1. PMID 11448586.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - Lauts N. "Management of the patient with refeeding syndrome". J Infus Nurs. 28 (5): 337–42. PMID 16205500.
- Kraft M, Btaiche I, Sacks G (2005). "Review of the refeeding syndrome". Nutr Clin Pract. 20 (6): 625–33. doi:10.1177/0115426505020006625. PMID 16306300.
{{cite journal}}: CS1 maint: multiple names: authors list (link)