Refeeding syndrome

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. Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described in Japanese war prisoners after the Second World War.

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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 after refeeding in combination with decreased intracellular phosphate stores. 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. Supplementing glucose and thiamine and monitoring serum electrolytes may help in renourishment.

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. PMID 15087326.
• Crook M, Hally V, Panteli J. "The importance of the refeeding syndrome.". Nutrition 17 (7-8): 632-7. PMID 11448586.
• 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. PMID 16306300.