Review of the Refeeding Syndrome

Department of Clinical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-0008, USA.
Nutrition in Clinical Practice (Impact Factor: 2.4). 01/2006; 20(6):625-33. DOI: 10.1177/0115426505020006625
Source: PubMed


Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid 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.

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Available from: Michael D Kraft
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    • "Patients who develop symptomatic RS need intensive treatment of electrolyte disturbances, vitamin deficiencies, supportive care, and, in many situations, interruption of nutritional support until RS is solved (Kraft et al. 2005). Oral phosphate supplements may be irregularly absorbed by the intestine leading to diarrhea (Ornstein et al. 2003). "
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    ABSTRACT: Refeeding syndrome is a group of electrolytic and metabolic disturbances that may occur as a result of nutritional support (oral, enteral, or parenteral), in severe malnourished patients. The syndrome was first described at the end of the Second World War and gained importance during the development of artificial nutrition. It is characterized by electrolyte disorders (hypophosphatemia, hypomagnesemia, and hypokalemia due to the movement of phosphate, magnesium, and potassium to the intracellular medium) and volume disbalance (water and sodium retention) mediated by insulin secretion during the reinstitution of nutrition. It can also appear as acute thiamine fall. The identification of patients at risk for developing refeeding syndrome should be a priority, in order to adjust the initial inputs of water, energy, electrolytes, and micronutrients.
    Full-text · Chapter · Jan 2015
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    • "Re-feeding syndrome is diagnosed by a history of severe malnutrition and re-feeding, the clinical symptoms of cardiovascular, respiratory, neurological or skeletomuscular systems, hypo- or hyperglycemia, and the abnormalities of fluid and electrolytes [4,7,10,11]. A differential diagnosis should be considered; including hemodialysis, diabetic ketoacidosis, sepsis, volume repletion, malabsorption and multiple medication usage, but treatment must be initiated early because of the high mortality rate after delayed diagnosis. "
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    ABSTRACT: Re-feeding syndrome is common in patients with long-term starvation. To the best of our knowledge this case is the first to report a patient with short bowel syndrome developing re-feeding syndrome 12 years after the bowel resection. A 33-year-old Chinese Han man underwent small bowel resection leaving only 40 cm of bowel, without an ileocecal valve, 12 years previously. At that time he was weaned from total parenteral nutrition and had a normal diet. He later developed features of severe malnutrition, and when parenteral nutrition was given, he developed re-feeding syndrome. Although re-feeding syndrome is a common complication in patients with any kind of nutritional support, and known to us for many years, high risk patients still need more attention and monitoring. Re-feeding syndrome in this case was not only a macronutrients deficiency but also a micronutrient deficient, and prompt supplement therapy and organ function support proved to be successful.
    Full-text · Article · May 2012 · Journal of Medical Case Reports
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    • "Glucose levels are maintained by glycogenolysis but glycogen stores rarely last more than 72 hours [11]. Glucose homeostasis is essential because certain tissues, such as brain, erythrocytes, and cells of the renal medulla are obligate glucose users [12]. These demands for glucose are met by the process of gluconeogenesis by which noncarbohydrate sources are metabolized to glucose. "
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    ABSTRACT: Refeeding syndrome (RFS) describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. RFS has been recognised in the literature for over fifty years and can result in serious harm and death. Crude estimates of incidence, morbidity, and mortality are available for specific populations. RFS can occur in any individual but more commonly occurs in at-risk populations. Increased awareness amongst healthcare professionals is likely to reduce morbidity and mortality. This review examines the physiology of RFS and describes the clinical manifestations. A management strategy is described. The importance of a multidisciplinary approach is emphasized.
    Full-text · Article · Jan 2011 · Gastroenterology Research and Practice
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