Risks and pitfalls for the management of refeeding syndrome in psychiatric patients

Marco Catani,Roger Howells

doi:10.1192/pb.bp.106.009878

Abstract

Aims and MethodWe present two patients who developed refeeding syndrome following admission to a general psychiatry ward. The practical implications of assessing and managing medical consequences in patients with mental illness who start refeeding after a period of starvation are discussed.ResultsPatients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage.Clinical ImplicationsAwareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications.

Highlights

In psychiatry, refeeding syndrome occurs in people with eating disorders and alcoholism (Cumming et al, 1987), but it is often missed in other psychiatric patients where malnutrition is relatively common
The consequences of missing a diagnosis of refeeding syndrome in these patients may be serious, as complications range from neurological disability to metabolic complications and death (Crook et al, 2001)
We describe refeeding syndrome in two patients routinely admitted to a general psychiatric ward and illustrate the potential pitfalls in the prevention, diagnosis and management of severe malnutrition and refeeding complications in patients with mental illness

Summary

Introduction

Patients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage. Awareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications. Refeeding syndrome can be defined as severe electrolyte and fluid shift associated with metabolic abnormalities in patients with malnutrition undergoing realimentation, whether orally, enterally, or parenterally (Crook et al, 2001).

Results

Conclusion