Risk of refeeding syndrome. Case report

Adriana Giraldo Villa

doi:10.15446/cr.v5n1.71140

Abstract

Introduction: Refeeding syndrome is an acute metabolic disorder that occurs during nutritional repletion. Although it has been known for years, the early detection of risk factors for its onset and the implementation of measures to prevent it are not common in nutritional care.Case presentation: 48-year-old male patient, in critical care for 6 days, with suspected Wernicke-Korsakoff encephalopathy and high risk of refeeding syndrome according to criteria of the National Institute of Health and Clinical Excellence. The subject received enteral nutrition with 14 kcal/kg for the first 3 days, with subsequent increases aiming to achieve a nutritional goal of 25 kcal/kg on day 5. He also received daily supplementation of thiamine 600mg, folic acid 5mg and pyridoxine 50mg. Blood phosphorus decreased from 3 mg/dL to 2 mg/dL the day after initiating the nutritional plan and normalized by day 3.Discussion: The patient did not present severe hypophosphatemia or clinical manifestations of refeeding syndrome. Hypophosphatemia was resolved by maintaining a stable caloric restriction during the first days. Some professionals consider this restriction as very conservative, and others think that it may lead to achieve significant improvements in mortality reduction.Conclusions: The strategy for assessing the risk of refeeding syndrome, nutritional management and implemented follow-up were successful in preventing the patient from developing a refeeding syndrome.

Highlights

Refeeding syndrome (RS) is an acute metabolic disorder that occurs during nutritional repletion
The strategy for assessing the risk of refeeding syndrome, nutritional management and implemented follow-up were successful in preventing the patient from developing a refeeding syndrome
At the beginning of the nutritional treatment, the patient presented a decrease of phosphorus of more than 30% with respect to its basal value; serum phosphorus normalized after maintaining a stable caloric contribution during the first three days of nutritional therapy

Summary

Introduction

Refeeding syndrome (RS) is an acute metabolic disorder that occurs during nutritional repletion. It has been known for years, the early detection of risk factors for its onset and the implementation of measures to prevent it are not common in nutritional care. The subject received enteral nutrition with 14 kcal/kg for the first 3 days, with subsequent increases aiming to achieve a nutritional goal of 25 kcal/kg on day 5. He received daily supplementation of thiamine 600mg, folic acid 5mg and pyridoxine 50mg. El fósforo en sangre disminuyó de 3 mg/dL a 2 mg/dL al día siguiente del inicio de la nutrición y se normalizó para el día 3

Discussion

Conclusions

INTRODUCTION

DISCUSSION

Assessment of risk factors for refeeding syndrome

Calorie intake according to the type of risk for refeeding syndrome

Findings

Diagnosis of refeeding syndrome

CONCLUSIONS