In 2006 a guideline was published by the national institute for health and clinical excellence nice in england and wales. Refeeding syndrome symptoms may occur when a person receives a large intake of carbohydrates following a period of starvation. Rfs has been recognised in the literature for over fifty years and can result in serious harm and death. All patients are different and will need to be monitored closely to determine the best approach to refeeding. One of the primary reasons for this lack of agreement is the inherent difficulty in studying patients with refeeding syndrome. This article will discuss the pathophysiology behind refeeding syndrome, identify. Increase calorie provision only as clinical condition and electrolyte results allow. The pathophysiology of refeeding syndrome has now been elucidated. This article discuss the physiology of starvation and the pathophysiology behind refeeding syndrome, identify the patients at greatest risk, and provide practical tips for prevention. In starvation with reduced intake of carbohydrates the secretion of insulin is decreased. This article discuss the physiology of starvation and the pathophysiology behind refeeding syndrome, identify the patients at greatest risk, and. This in turn, causes fluid imbalances in the body, leading to the potentially. Pathophysiology, treatment, and prevention of fluid and. Refeeding syndrome nutrition therapy department reference of diabetes, endocrinologyinitial energyday, nutritional medicine and metabolismproteins, university hospital, bern, switzerland fluidsdayzeno stanga vitamins beforeduringespen 2016 solomon et al.
The underlying causative factor of refeeding syndrome is the metabolic and hormonal changes caused by rapid refeeding, whether enteral or parenteral. Refeeding syndrome in the setting of chronic malnutrition, especially with chronic electrolyte losses, the administration of parenteral nutrition can result in refeeding syndrome. The syndrome is expected to lower levels of important minerals. Refeeding syndrome was first described in the 1940s.
This article will discuss the pathophysiology behind refeeding syndrome, identify patients at greatest risk, and provide practical tips for prevention. If electrolytes become imbalanced as digestion resumes, a person can develop refeeding syndrome. From the department of chemical pathology, guys and st thomas hospital and. Refeeding syndrome is a metabolic disturbance that occurs as a result of reinstitution of nutrition to people who are starved, severely malnourished or metabolically stressed due to severe illness. Refeeding of previously starving patients may lead to a variety of. Refeeding syndrome is a well described but often forgotten condition. A severe shift in electrolytes takes place when an individual consumes a quantity of complex carbohydrates after a prolonged period of food deprivation.
Abnormal glucose and lipid metabolism can potentially trigger hyperglycaemia and. With extended periods of nutrition deprivation, survival depends on the ability to efficiently use and preserve available energy reserves. Review article the importance of the refeeding syndrome. Prevention and treatment of refeeding syndrome in the. The net result of metabolic and hormonal changes in early starvation is that the body switches from using carbohydrate to using fat and protein as the main source of energy, and the basal. We provide suggestions for the prevention and treatment of refeeding syndrome. Crude estimates of incidence, morbidity, and mortality are available for specific. The pathophysiology of refeeding syndrome has now been established.
Prevention of refeeding syndrome in the outpatient setting. Refeeding syndrome is a potentially life threatening condition that occurs with administration of high calorie feeds in severely malnourished children. Pulcini, md, med, mph, stacey zettle, ms, rd, ldn, arvind srinath, md department of pediatrics, department of clinical nutrition, and division of pediatric gastroenterology, hepatology, and nutrition, childrens hospital of pittsburgh of university of pittsburgh medical center upmc, pittsburgh, pa. Patients at high risk of refeeding syndrome commence nutrition support at a maximum of 10kcalskg body weight. Guidelines for prevention and management of refeeding. Rs is a common phenomenon in malnourished patients with a previous depletion of lean body. Introduction refeeding syndrome rfs is a constellation of potentially fatal metabolic derangements that may occur in the context of recommencement of caloric supplementation after a prolonged period of malnutrition. Fluid intolerance in refeeding syndrome may result in cardiac failure, dehydration or fluid overload, hypotension, prerenal failure and sudden death. What electrolytes and minerals are involved in the pathogenesis. A final diagnosis of chronic alcoholic malnutrition with refeeding syndrome was made. It should be noted that for patients who are not deemed to be at risk of refeeding syndrome, faster refeeding rates are recommended.
In the iugr neonatal population, we hypothesize that the pathophysiology of hypophosphatemia, hypokalemia and hypomagnesemia is similar to that of other patients at risk for refeeding syndrome. Parallels between treated uncontrolled diabetes and the. It should be started immediately and may last for at least 10 days. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. Oral feeding of severely malnourished people reported to result in diarrhoea, heart failure and coma with overall 35% case fatality rate. Parallels between treated uncontrolled diabetes and the refeeding syndrome with emphasis on fluid and electrolyte abnormalities robert matz diabetes care oct 1994, 17 10 120912. Refeeding syndrome was first described in far east prisoners of war after the second world war. Screening, incidence, and treatment during parenteral nutrition russell s walmsley north shore hospital, and faculty of medicine, university of auckland, auckland, new zealand key words hypophosphatemia, parenteral nutrition, refeeding syndrome. The importance of the refeeding syndrome johns hopkins medicine. Refeeding syndrome encompasses abnormalities affecting multiple organ systems, including neurological, pulmonary, cardiac, neuromuscular and haematological functions.
The term refeeding syndrome rs is generally reserved to describe the metabolic alterations that occur during nutrition repletion of underweight, severely malnourished, or starved individuals. If severe, refeeding syndrome may result in re s p i r a t o ry, cardiac, and neuro m u scular dysfunction, especially in the stressed, elderly, or severely malnourished patient. Refeeding is reintroducing food after a period of malnourishment or starvation. Under conditions of normal energy intake, metabolic substrates will change diurnally, cycling through postprandial, postabsorptive, and fasting states. Lipolysis and body protein breakdown occurs to produce energy.
Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. This potentially fatal condition is associated with electrolyte disturbances including hypokalemia and hypophosphatemia. A to understand the etiology of refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment. Prevention of refeeding syndrome in the outpatient setting jennifer logan, m. Refeeding syndrome can be effectively prevented and treated if its. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death. The important electrolytes may also be substituted using different routes such as oral, enteral, or parenteral, depending on which strategy can possibly be utilized. Is underdiagnosed and undertreated, but treatable refeeding syndrome was first described in far east prisoners of war after the second world war. Pdf physiology of starvation and refeeding syndrome.
Refeeding syndrome rfs describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. The refeeding syndrome rfs is a serious complication in patients receiving nutrition support after a period of severe malnutrition. Refeeding syndrome this is an extremely serious pathological condition in which a malnourished individual starts receiving feeding again, which may cause serious metabolic and hormonal changes which can be potentially fatal in some cases. Refeeding syndrome is a lifethreatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Hyperinsulinemia has prominent role in refeeding syndrome. Refeeding problems have been recognised since the the liberation of starved communities under siege. When too much food or liquid nutrition supplement is eaten during the initial four to seven days, this triggers the production of glycogen, fat and protein in cells, to the detriment of serum. Refeeding syndrome symptoms, definition, treatment. The refeeding syndrome refeeding syndrome first recognised clinically in the mid1940s.
Patients at moderate risk of refeeding syndrome introduce nutrition support at a maximum of 50% of requirements for the first 2 days. In the early stages of refeeding, it is particularly. We frequently recognize and diagnose the rfs due to increased. This article will discuss the pathophysiology behind refeeding syndrome, identify patients at greatest risk, and provide practical tips for prevention and treatment. A to identify the patients who are at risk of refeeding syndrome. Management of refeeding syndrome in critical illness. Pathophysiology of electrolyte disturbances to consider in refeeding syndrome management the most important aspect of management is being aware of patients with risk factors for developing rfs. Aspen consensus recommendations for refeeding syndrome. Refeeding is the process of reintroducing food after malnourishment or starvation. The pathophysiology of the refeeding syndrome copenhagen 18.