Management and prevention of refeeding syndrome in medical. Pdf refeeding syndrome is a lifethreatening condition that often goes unrecognized. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of. Mechanism posted on june 5, 2018 june 11, 2018 by medicine specifics team refeeding syndrome is a set of clinical complications that typically occur in severely malnourished patients as a result of aggressive fluid and electrolyte shifts during oral, enteral, or.
Inpatient treatment of anorexia nervosa and refeeding syndrome. Dutch consensus statement on refeeding syndrome introduction disease related malnutrition is a common problem in health care. Aspen consensus recommendations for refeeding syndrome. Refeeding syndrome should be suspected in a patient where nutrition was recently reintroduced when there is a 20% drop in a patients phosphorus, potassium, or magnesium levels. Another critical electrolyte in the refeeding process is potassium. If a person does not eat enough, the body can quickly go into starvation mode and become malnourished. Oral feeding of severely malnourished people reported to result in diarrhoea, heart failure and coma with overall 35% case fatality rate.
Nursing interventions needed in preventing refeeding. Aug 25, 2010 refeeding syndrome rfs describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. Jan 12, 2014 nutritional refeeding syndrome kwashiorkar and marasmus indore pedicon 2014 1. The refeeding syndrome refeeding syndrome first recognised clinically in the mid1940s. Treatment of hypophosphatemia is usually not necessary unless the plasma. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. Refeeding syndrome symptoms, definition, treatment. The incidence of refeeding syndrome in veterinary patients has not been determined. Refeeding patients with anorexia nervosa eating disorder hope.
Review article the importance of the refeeding syndrome. The refeeding syndrome is a rare, survivable phenomena that can occur despite identification of risk and hypocaloric nutritional treatment. Refeeding syndrome is a serious and potentially fatal condition. This policy has been developed to provide a guide to managing the risk of refeeding syndrome in the hospital wards. Refeeding syndrome rfs encompasses the clinical complications that occur as a result of fluid and electrolyte shifts during nutrition repletion of malnourished patients. Therefore, special attention must be given at the initiation of food replenishment. Nursing interventions needed in preventing refeeding syndrome in anorexia nervosa inpatients. Refeeding guideline refeeding is indicated only when there is evidence of nutritional deficiency, e. Awareness and identification of atrisk patients is crucial to improving management. Causes of refeeding syndrome in a manner similar to humans, the feeding of concentrated calories to a starving horse can lead to a condition called re feeding syndrome. Nutrition support clinicians refer to the abnormalities in laboratory data and changes in clinical signs and symptoms that follow refeeding of starved or malnourished patients as refeeding syndrome.
During starvation, intracellular electrolytes become depleted from fat and protein catabolism. Apr 15, 2004 refeeding syndrome can occur with parenteral as well as enteral feeding. Refeeding syndrome can be fatal if not recognized and treated properly. The refeeding syndrome rfs is a serious complication in patients receiving nutrition support after a period of severe malnutrition. Rfs has been recognised in the literature for over fifty years and can result in serious harm and death. Refeeding syndrome a practical approach peng prebapen conference teaching day birmingham. Management of refeeding syndrome in critical illness. All adult patients should be referred to a dietitian for specialist advice. Risk groups and pathogenesis the refeeding syndrome is seen in. This study shows that even hypocaloric feeding should be considered a susceptibility factor for the refeeding syndrome. An intravenous phosphorus repletion regimen proposed by vannattaet al7 became popularized at about the same time as the refeeding syndrome reports from weinsier and krumdieck. In a starved body, there is a breakdown of fat and muscle, which leads to losses in some electrolytes like potassium, magnesium, and phosphate. Refeeding syndrome can occur when food is reintroduced to a person who is malnourished.
Case scenario ram a 18 month old boy was brought to hospital with co poor weight gain. Nutritional recovery refeeding syndromekwashiorkar and marasmus dr rajesh kulkarni pune 2. Refeeding syndrome among older adults full text view. Rf is severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally, or parenterally. Theoretical descriptions of refeeding syndrome include a complex and extensive list of changes, such as hypophosphatemia, hypomagnesemia. Selenium and zinc may also benefit patients at risk for the refeeding syndrome and are generally included in standard. Incidence rates for rfs highly depend on the definition used. Refeeding syndrome precipitate when fatal shifts in fluids and electrolytes occur in malnourished patients is. Refeeding syndrome rfs adalah suatu kondisi dimana terjadi perubahan klinis dan metabolik yang timbul akibat rehabilitasi nutrisi yang agresif pada pasien yang menderita malnutrisi berat.
Refeeding syndrome rfs is a dangerous metabolic condition after nutritional replenishment if not recognized early and treated adequately. When a severely malnourished patient is given glucose, the following cascade of events takes place. Refeeding syndrome or refeeding hypophosphatemia skipper. The metabolic and physiologic processes that occur as a consequence of depletion during starvation and repletion during refeeding. The refeeding syndrome is defined as the severe and potentially fatal shifts in fluid and electrolytes that may develop when initiating oral, enteral or parenteral nutrition of severely malnourished patients. The first documented cases were reported in 1949 when world war ii soldiers were being rescued by allied troops, brought back and fed. Prevention and treatment of refeeding syndrome in the. Crude estimates of incidence, morbidity, and mortality are available for specific populations. Refeeding syndrome is a lifethreatening condition that often goes unrecognized. Before we answer that question, lets first define refeeding syndrome rf. Refeeding syndrome a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support.
Refeeding syndrome an overview sciencedirect topics. The purpose of this thesis was to describe nursing interventions that are needed to prevent refeeding syndrome in. An awareness of the condition and a high index of suspicion are required in order to make the diagnosis. Refeeding syndrome is found in those who undergo reinstitution of enteral or parenteral feeds after a prolonged period of malnutrition or anorexia. 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. Nutritional refeeding syndrome kwashiorkar and marasmus. Dutch consensus statement on refeeding syndrome introduction. Im hoping to go as long as three weeks for my fast, but im going to stay realistic and take it one day at a time and listen to my body.
Refeeding syndrome inadequate awareness and confidence knowledge of the refeeding syndrome poor among paediatric middlegrade doctors. For more information on subscription options, click below on the option that best describes you. Much ado about refeeding university of virginia school of. Much ado about refeeding university of virginia school. This bedside tool defines refeeding syndrome and provides information on monitoring patients at risk for refeeding syndrome, and adjusting the initiation and titration of feeds in those patients. The primary aim of refeeding is to alleviate the short and long term physical and psychological sequelae of malnutrition. Magnesium is required for more than 300 enzyme pathways. Jun 28, 2008 refeeding syndrome is a well described but often forgotten condition. Psychosomatic molecular mechanisms of metabolic syndrome and. Practically essential issues such as refeeding syndrome are also analyzed. Refeeding syndrome involves metabolic abnormalities when a malnourished person begins feeding, after a period of starvation or limited. Nursing interventions needed in preventing refeeding syndrome.
During early refeeding, phosphorus levels can become dangerously low leading to muscle damage, weakness, cardiac arrhythmias, and death. In addition to intracellular trapping and decreased total body stores, other factors contribute to the decreased serum electrolyte levels and clinical symptoms observed with refeeding. Talk with your doctor and family members or friends about deciding to join a study. Refeeding syndrome involves metabolic abnormalities when a malnourished person begins feeding, after a period of starvation or limited intake.
Dec 12, 2018 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. Occurrence of refeeding syndrome in adults started on artificial. Refeeding syndrome can wreak havoc on nearly every body system and have a variety of physical consequences, including respiratory, cardiac, neurologic, gastrointestinal, and skeletal problems. In the united kingdom patients with anorexia nervosa, cancer, alcoholism, and some patients after operations are known to be at risk of refeeding syndrome. Can we feed a mnemonic to merge nutrition and intensive care assessment of the. Although it has been known for years, the early detection of risk factors for its onset. Sep 12, 2010 protocols for repletion of hypophosphatemia have been refined since the early reports of refeeding syndrome in recipients of nutrition support. Below is a list of common natural remedies used to treat or reduce the symptoms of refeedingsyndrome. Cnsg east cheshire nhs trust guidelines for prevention and management of refeeding syndrome in adults page 4 of 11 1. Definitions for rfs rely on electrolyte disturbances with or without clinical symptoms. Refeeding syndrome is a series of metabolic complications linked to artificial nutritional support in patients who are severely malnourished, with conditions such as kwashiorkor, chronic malnutrition, or anorexia nervosa. The society for adolescent health and medicine published a position paper stating that. Evidence from a focussed rct conducted in critically ill patients with refeeding syndrome is required to inform and guide practice. No randomised controlled trials of treatment have been published, although there are.
In 2006 a guideline was published by the national institute for health and clinical excellence nice in england and wales. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. Refeeding syndrome is caused by rapid refeeding after a period of undernutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications. Medical director chief of adult psychiatry and eating disorders unit rosewood center for eating disorders. Refeeding syndrome is potentially fatal, yet is preventable. Nice recommends for patients at risk of refeeding syndrome that the patient is prescribed oral thiamin 200300 mg daily, vitamin b co strong 1 or 2 tablets, three.
Pdf refeeding syndrome rfs is commonly seen in different settings. Most of risk factors for rfs are in accordance with the national institute for health and care excellence. These electrolyte levels do not always appear to be low in. Feeding adult patients at risk of refeeding syndrome need to be monitored and assessed daily in their usual environment and the guidelines below followed. What a trainee surgeon should know about refeeding syndrome. The importance of the refeeding syndrome johns hopkins medicine. Much ado about refeeding may be at highest risk for complications from refeeding syndrome, possibly due to decreased cardiac, respiratory and muscle reserve. Treatment must still be tailored to an individuals needs.
Risk factors any or all npoclear fluids 710 days chronic etoh useabuse 10% wt loss over past 6 mths physical signs of malnourishment refeeding syndrome the metabolic and physiologic processes that occur as a consequence of depletion during starvation and repletion during refeeding. Establish bmi, degree of unintentional weight loss in the last 36 months, period of little or no nutritional intake, potassium magnesium and phosphate levels. The refeeding mantra for many years has been start low and go slow. Rfs is most critical in the first 72h period upon refeeding. Refeeding syndrome is a potentially lethal condition that occurs when aggressive nutrition is recommenced in someone who has metabolically adapted to starvation. These facts emphasize the significance of having sound knowledge of the careful reinstitution. Refeeding syndrome occurs when patients that have been starved begin to eat and. Guidelines for prevention and management of refeeding. Refeeding syndrome is an acute metabolic disorder that occurs during nutritional repletion. Outline importance of knowing about refeeding syndrome across disciplines. Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may. Refeeding syndrome in anorexia nervosa pdf free download. 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 blood.
Refeeding syndrome awareness, prevention and management. Haas germany espen barcelona the refeeding syndrome in anorexia. The electrolyte disturbances of the refeeding syndrome can occur within the first few days of refeeding. Jan 06, 2020 refeeding is the process of reintroducing food after malnourishment or starvation. Dec 29, 2016 the key electrolyte in refeeding syndrome is phosphorus, a crucial component of the bodys energy molecules. Refeeding syndrome is a well described but often forgotten condition. Refeeding syndrome in parenteral feeding rs walmsley 114 journal of gastroenterology and hepatology 20.
Hudson et al 20% unable to define it at all 21% able to identify some clinical features 57% aware of potential phosphate abnormalities higher levels of confidence in gastroenterologists vs general. Refeeding syndrome rfs describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. This syndrome can cause kidney, heart and respiratory failure 3 to 5 days after the first feeding. Common vitamins and supplements to treat refeedingsyndrome. Definisi lain mengatakan refeeding syndrome rfs adalah kondisi yang mengancam jiwa. Sudden drop in vital minerals can pose lifethreatening symptoms to a patient suffering from refeeding syndrome, and it can potentially be irreversible. Prevention and treatment of refeeding syndrome in the acute. Refeeding syndrome rfs is a clinical entity occurring in severely. Refeeding is the process of reintroducing food after malnourishment or starvation. Identification of those at risk 1 refeeding syndrome. However, i was really alarmed reading about refeeding syndrome which seems pretty serious and dangerous, particularly if youre doing this by yourself. Condition or disease, interventiontreatment, phase. Refeeding syndrome nutrition therapy department of diabetes, endocrinology, nutritional medicine and metabolism, university hospital, bern, switzerland zeno stanga espen 2016 learning objektives to rise awareness regarding rfs management to identify patients who are at risk of rfs to understand how safe nutrition therapy is. The survival chances of refeeding syndrome patients may depend on how immediate interventions are done to address the condition.
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