Refeeding Syndrome In Patients Research Articles

Management of refeeding syndrome in patients receiving parenteral nutrition: retrospective audit from the Cambridge University Hospitals Trust

Management of refeeding syndrome in patients receiving parenteral nutrition: retrospective audit from the Cambridge University Hospitals Trust

Research progress in the recognition and prevention of refeeding syndrome in patients with head and neck cancer

Patients with head and neck cancer are one of the populations with high incidence of malnutrition. The nutritional support methods include oral feeding, enteral nutrition and parenteral nutrition. Refeeding syndrome, as a nutrition-related metabolic disease, often occurs in patients with head and neck cancer (HNC)when they re-feed. This article reviews the nutritional management of patients with head and neck cancer, the identification and prevention of refeeding syndrome in patients with head and neck cancer, in order to provide scientific basis for clinical staff to effectively identify and prevent refeeding syndrome.

Refeeding syndrome in patients with anorexia nervosa - case reports

Abstract Introduction: Refeeding syndrome RS is a life-threatening acute hormonal and metabolic disorder that occurs in patients with moderate or severe malnutrition as a result of improperly administered nutritional therapy. Material and method: The aim of this study is to describe the cases of two female patients suffering from anorexia nervosa, who developed a refeeding syndrome after starting nutritional therapy. Additionally, the available literature was reviewed in order to characterize the issue, including negative consequences and prevention of the refeeding syndrome. Results: In both cases, the development of the refeeding syndrome was found in the patients, resulting from the excessive supply of energy and nutritional substrates in a short time, preceded by a previous, months long period of starvation and exhaustion of the organism (both patients had a decrease in the body mass index - BMI - to the value of about 14 kg / m2). In patient 1, the symptoms concerned mainly the cardiovascular system: a significant increase in the concentration of N-terminal B-type natriuretic propeptide (NT-proBNP) and tachycardia, as well as a decrease in the concentration of inorganic phosphates and hypokalemia. On the other hand, in the case of patient 2, symptoms such as confusion or deep disturbances of consciousness, which led to hospitalization in the intensive care unit, dominated the clinical picture. Conclusions: Refeeding syndrome may develop during nutritional rehabilitation, especially in the case of a sudden, inadequately planned supply of nutrients. Particular care should be taken in patients with extremely low BMI when reintroducing nutrition. The presented case reports draw attention to the possibility of cardiological complications and mental disorders of the realimentation syndrome, and indicate the behavior of patients (eating excessive food) that may lead to the development of the refeeding syndrome.

An unexpectedly high incidence of refeeding syndrome in patients with total parenteral nutrition in a reference university hospital

Refeeding syndrome occurs with the reintroduction of food after an individual has undergone a substantial period of malnutrition. The development of this condition is not uncommon but is neglected in most cases. To identify the incidence of refeeding syndrome in hospitalized patients undergoing total parenteral nutrition and factors that may be associated with this condition. Observational retrospective and prospective cohort study. Data collection took place at the Hospital de Clínicas de Porto Alegre, from 2015 to 2018. Data was collected consecutively from patient electronic medical records. All hospitalized individuals aged 18 years or more and having a prescription for total parenteral nutrition were included in the study. Exclusion criteria included patients with diabetic ketoacidosis; receiving renal replacement therapy or chronic kidney disease with a glomerular filtration rate <30mL/min; severe metabolic acidosis or any disease that could affect serum phosphorus levels. WinPepi software, version 11.65, was used to calculate sample size. Data analysis was performed using SPSS version 20.0. A 5% significance level was considered for the established comparisons. The project was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre (number 17-0313). Data from 97 patients was collected. The incidence of refeeding syndrome in our sample was 43.3% (n=42). Factors positively associated with the syndrome were use of standard parenteral nutrition (p<0.01), advancing age (mean 62.8yr versus 55.1yr; p=0.013), and amount of total energy administered, which were 25.6kcal/kg/day versus 23.6kcal/kg/day for patients with and without refeeding syndrome, respectively (p<0.01). The incidence of refeeding syndrome in individuals using total parenteral nutrition was high. The supply of a greater quantity of total energy in the first week of nutritional therapy, the absence of electrolytes in the parenteral nutrition solution and advancing age were all factors associated with the emergence of refeeding syndrome.

Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

Refeeding syndrome is a life-threatening condition that occurs when nutrition is restarted in patients with initial malnutrition. For the first time refeeding syndrome was described more than 70 years ago but it still has not been studied enough. The pathophysiology of refeeding syndrome is based on severe electrolyte and metabolic disorders caused by the restoration of nutrition with an initial deficiency of phosphorus, potassium, magnesium which lead to organ failure. Hypophosphatemia is the main feature of the refeeding syndrome while in ICU patients there are many other causes of hypophosphatemia which complicates diagnostics. Most studies on refeeding syndrome have been conducted among patients with anorexia nervosa. In ICU refeeding hypophosphatemia occurs in about 34 % of cases but until recently all guidelines for the management of this condition have been extrapolated from the practice of treatment anorexia nervosa and were based on expert opinion. Several major studies have proven the effectiveness of a hypocaloric feeding during refeeding syndrome in critically ill patients recently. This review is devoted to the problem of refeeding syndrome in patients with anorexia nervosa and critical care patients, differential diagnostics and treatment approaches for this condition.

Prevention and management of refeeding syndrome in patients with chronic critical illness

Nutritional support is an important means to treat the patients with chronic critical illness for commonly associated malnutrition. Refeeding syndrome is a serious complication during the process, mainly manifested as severe electrolyte with hypophosphataemia being the most common. Refeeding syndrome is not uncommon but it is often ignored. In our future clinical work, we need to recognize this chinical situation and use preventative and treatment measures. According to NICE clinical nutrition guideline, we discussed the risk factors, treatment methods and preventive measures of refeeding syndrome in patients with chronic critical illness. We argued that for patients with high risk refeeding syndrome, nutritional support treatment should be initially low calorie and slowly increased to complete requirement. Circulation capacity should be recovered, fluid balance must be closely monitored and supplement of vitamins, microelement, electrolytes should be noted. After the emergence of refeeding syndrome, we should reduce or even stop the calorie intake, give an active treatment for electrolyte disorder, provide vitamin B, and maintain the functions of multiple organs.

Delirium and refeeding syndrome in anorexia nervosa

To review the literature on delirium and refeeding syndrome in patients with anorexia nervosa (AN) and present case examples in an attempt to identify common clinical features and response to therapy. A comprehensive literature review was completed. In addition to the cases identified in the literature, we present two additional cases of our own. We identified a total of 10 cases (all female; mean age 19 years old, range 12-29 years); 2/3 of the cases had similar clinical features predating the delirium and during refeeding. Delirium, albeit rare, can be associated with the refeeding syndrome in low weight patients with AN. During the initial refeeding phase, close monitoring of medical, metabolic, and psychological parameters are important in establishing factors that may elevate risk. Early detection and treatment of delirium using nonpharmacologic and pharmacologic means are also important to help minimize the effects of this potentially deadly condition.

Complications and monitoring - Guidelines on Parenteral Nutrition, Chapter 11.

Compared to enteral or hypocaloric oral nutrition, the use of PN (parenteral nutrition) is not associated with increased mortality, overall frequency of complications, or longer length of hospital stay (LOS). The risk of PN complications (e.g. refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections) can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. Occuring complications are e.g. the refeeding-syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycaemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis. Efficient monitoring in all types of PN can result in reduced PN-associated complications and reduced costs. Water and electrolyte balance, blood sugar, and cardiovascular function should regularly be monitored during PN. Regular checks of serum electrolytes and triglycerides as well as additional monitoring measures are necessary in patients with altered renal function, electrolyte-free substrate intake, lipid infusions, and in intensive care patients. The metabolic monitoring of patients under long-term PN should be carried out according to standardised procedures. Monitoring metabolic determinants of bone metabolism is particularly important in patients receiving long-term PN. Markers of intermediary, electrolyte and trace element metabolism require regular checks.

Central Pontine Myelinolysis as a Complication of Refeeding Syndrome in a Patient With Anorexia Nervosa

Central Pontine Myelinolysis as a Complication of Refeeding Syndrome in a Patient With Anorexia Nervosa

Refeeding syndrome in hospital patients referred for enteral and parenteral nutrition

Background: The reported incidence of refeeding syndrome is highly variable due to the heterogeneity of its definition, the electrolyte reference ranges used, patient populations investigated and the treatment protocols implemented (Marik &amp; Bedigian, 1996; Fan et al., 2004). Recent guidelines have been published by the National Institute of Clinical Excellence on the identification and management of patients at risk of refeeding syndrome (NICE, 2006). The aim of this prospective observational study was to determine the incidence of refeeding syndrome in hospital patients referred for artificial nutrition and hydration (ANH) via the enteral or parenteral route, where national practice guidelines exist to prevent its occurrence.Methods: Data was collected as part of a larger, ongoing study at a London hospital. All patients referred to the Department of Nutrition and Dietetics for ANH had their feeding regimen and their risk of refeeding syndrome determined based upon the clinical decision of their dietitian and local guidelines. An independent researcher screened patients for inclusion into the study and then categorised their risk of refeeding syndrome based upon criteria from national guidelines (NICE, 2006). Patient characteristics, diet history, anthropometry, feed prescription and baseline serum phosphate, potassium and magnesium were recorded. Electrolytes were recorded every 3 days, up to 15 days, to determine clinical signs consistent with refeeding syndrome. Patients ‘at risk’ of refeeding syndrome were compared with those categorised as ‘not at risk’. Statistical analysis was conducted using SPSS version 15 and included descriptive statistics, McNemar's test and independent t‐tests for continuous data. Ethical approval was obtained from the appropriate committee.Results: Of the 24 patients recruited, only three (13%) were judged to be ‘at‐risk’ of refeeding syndrome by the patient's dietitian, compared with 18 (75%) who were identified as ‘at‐risk’ based upon criteria from national guidelines (P &lt; 0.001). There were no significant differences in energy prescription (P = 0.836), energy delivery on the first day of feeding (P = 0.814) or serum electrolyte concentrations at any time point during feeding, when comparing patients identified as ‘at‐risk’ or ‘not at‐risk’ by national guidelines. Refeeding syndrome was not observed.Discussion: Adherence to the NICE guidelines (2006) for preventing refeeding syndrome was variable in these patients. However, patients identified as being ‘at‐risk’ according to these guidelines did not develop refeeding syndrome, despite frequently receiving energy prescriptions in excess of the recommendations.Conclusions: Patients who were categorised as ‘at risk’ of refeeding syndrome according to national guidelines did not always go on to develop the syndrome. The role of dietetic assessment of risk of refeeding syndrome warrants further investigation.References Fan, C., Ren, J., Wang, X. &amp; Li, J. (2004) Refeeding syndrome in patients with gastrointestinal fistula. Nutrition 20, 346–350.Marik, P.E. &amp; Bedigian, M.K. (1996) Refeeding hypophosphatemia in critically ill patients in an intensive care unit. Arch. Surg. 131, 1043–1047.National Institute for Clinical Excellence/National Collaborating Centre for Acute Care, February 2006. Nutrition support in adults. Oral nutrition support, enteral tube feeding and parenteral nutrition. London: National Collaborating Centre for Acute Care.

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

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.

Refeeding syndrome in patients with gastrointestinal fistula

Objective Although refeeding syndrome has been well documented in starved patients, obese patients, those with anorexia nervosa, malnourished elderly individuals, and certain postoperative patients, little is known about the presence and the importance of refeeding syndrome in patients with gastrointestinal fistula and insufficient nutrition support over the long term. The objective of this study was to estimate the morbidity of this syndrome in these patients, to assess the safety and efficacy of our graduated refeeding regimen, and to emphasize the importance of this syndrome. Methods One hundred fifty-eight patients with gastrointestinal fistula during the past 2 y were reviewed. Results Fifteen of these patients were diagnosed as having refeeding syndrome. They were started on the refeeding procedure according to our regimen, and changes in their serum levels of electrolytes were recorded. The symptoms and signs they presented were noted. All patients were successfully advanced to full nutrition support. During the refeeding procedure, patients presented with weakness, paralysis of limbs, slight dyspnea, paresthesia, tachycardia, edema, and diarrhea. Serum phosphorus concentration decreased in all patients within 24 h of refeeding, reaching a mean nadir after 3.3 ± 1.5 d and another 6.1 ± 2.1 d to return to above 0.70 mM/L upon phosphorus supplementation. Three patients treated with growth hormone presented more severe hypophosphatemia (<0.20 mM/L) than the others. Conclusions 1) Refeeding syndrome occurs commonly in patients with malnutrition secondary to gastrointestinal fistula. 2) Alterations in phosphate metabolism are central to the refeeding syndrome. 3) Supplementation with electrolytes (including especially phosphate) and vitamins is the focal point of the treatment of this syndrome. 4) Growth hormone treatment may aggravate hypophosphatemia.