Refeeding syndrome

Describe the etiology and risk factors for the refeeding syndrome in patients receiving PN. 

PN therapy is associated with significant complications, both with short- and long-term therapy. Many complications are related to overfeeding (Table 97—7). Metabolic complications include hyperglycemia, hypoglycemia, hyperlipidemia, hypercapnia, electrolyte disturbances, refeeding syndrome, and acid-base... 

Kraft MD, Btaiche IF, Sacks GS. Review of the refeeding syndrome. Nutr Clin Pract 2005 20 625-633. 

Add magnesium and phosphorous if patient at risk for refeeding syndrome or if baseline values are abnormal... 

It is extremely important to select the correct type of nutrition when feeding severely malnourished individuals or patients. The provision of food can be dangerous unless carefully controlled as it can lead to what is known as the refeeding syndrome . This is characterised by a rapid increase in extracellular volume, due to increased sodium intake, and decreased blood levels of phosphate and potassium due to increased levels of insulin which stimulate the entry of these into muscle. (The latter changes are also seen when type 1 diabetic patients in a severe hyper-glycaemic state are treated with insulin.) A recommended refeeding schedule is as follows ... 

Crook MA, Hally V and Panteli JV (2001) The importance of the refeeding syndrome. Nutrition 17 632-637. 

As SC has eaten little for more than 5 days, she is at risk of refeeding syndrome. NICE (2006) recommend that parental nutrition should be introduced at no more than 50% of the requirements for the first 2 days for those at risk of refeeding syndrome. 

Refeeding syndrome is defined by Crook et al. (2001) as severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally or parenterally. ... 

Daily for first 3-4 days after initiation of TPN Add magnesium and phosphorous If pafient at risk for refeeding syndrome or if baseline values are abnormal Serum elecirolytes may be measured less frequently In stable patients... 

Malignant neoplasms Fanconi s syndrome Acute volume expansion Metabolic acidosis Renal transplantation Vitamin D deficiency and/or resistance Diuretics Acetazolamide Osmotic agents Glucocorticoids Sodium bicarbonate Internal redistribution Refeeding syndrome Parenteral nutrition... 

Solomon SM, Kirby DE. The refeeding syndrome A review. JPEN J Parenter Enteral Nutr 1990 14 90-97. 

NPC N nonprotein-calorie nitrogen ratio PN parenteral nutrition PPN peripheral parenteral nutrition PUPA polyunsaturated fatty acid RDA recommended daily allowance RS refeeding syndrome TNA total nutrient admixture TPN total parenteral nutrition USP United States Pharmacopeia... 

Brooks MJ, Melnik G. The refeeding syndrome An approach to understanding its complications and preventing its occurrence. Pharmacotherapy 1995 15 713-726. 

Patients with renal failure will typically require lower amounts of potassium, magnesium, and phosphorus in the nutritional regimen unless refeeding syndrome is presenter continuous renal replacement therapies are used. 

Metabolism Refeeding syndrome is normally associated with large calorie loads delivered by parenteral or enteral feeding. Acute respiratory failure has been attributed to refeeding syndrome induced by hypocaloric enteral tube feeding [81 ]. 

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. This study shows that even hypocaloric feeding should be considered a susceptibility factor for the refeeding syndrome. 

Patel U, Sriram K. Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition. Nutrition 2009 25 364-7. 

If admission s required, feeding must be established safely and immediately to prevent death from malnutrition. However, feeding too rapidly causes refeeding syndrome, which can kill. 

Refeeding syndrome in a small-for-date infant receiving early PN has been reported [121 ]. 

Mizumoto H, Mikami M, Oda H, Hata D. Refeeding syndrome in a smaU-for-dates micro-preemie receiving early parenteral nutrition. Pediatr Int October 2012 54(5) 715-7. 

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