There are also studies that indicate the refeeding syndrome may develop after as little as 48 hours with no nutritional intake. It is often thought that enteral feeding should be initiated slowly in those who are severely malnourished. A descriptive study completed at the Richmond Hospital examined the effect of an enteral feeding protocol on the typical metabolic consequences seen in refeeding syndrome.
A retrospective chart review of 51 patients placed on hospital-wide enteral feeding and electrolyte replacement protocols over a nine-month period, tried to determine whether there were any negative clinical consequences to early feeding.
Independent cardiac arrhythmias, which are high risk from electrolyte imbalances, must also be ruled out, such as long QT syndrome. Prognosis is variable based on the severity of biochemical and electrolyte changes.
Of note, many refeeding syndrome patients have comorbidities such as electrolyte and vitamin deficiencies that may be exacerbated in the setting of alcohol use disorder and worsen prognosis. Electrolyte imbalance from refeeding syndrome can result in several complications. As outlined in Table 1 for the main electrolyte imbalances, Potassium imbalances can lead to cardiac arrhythmias, QT prolongation weakness, fatigue, paralysis, respiratory distress.
Phosphorus can lead to cardiac arrhythmias, decreased 2,3 DPG production, decreased respiratory muscle function. Magnesium can lead to ataxia, vertigo, paresthesia, convulsions, depression, QT prolongation.
Thiamine deficiency can lead to cardiac dysfunction, Wernicke, and Korsakoff syndrome. Identification of high-risk patients for refeeding syndrome is crucial for the prevention of refeeding syndrome development and complications. High-risk features are discussed previously in this article. NICE has established guidelines for the prevention of refeeding syndrome following the identification of a high-risk patient. These guidelines include incorporating a nutritional assessment before replenishment, checking baseline electrolyte levels and monitoring for two weeks in this setting, and screening for recent weight changes, alcohol use, or nutritional changes.
Further education surrounding the etiology and characteristics of refeeding syndrome may be beneficial for providers, especially in the ICU environment. Refeeding syndrome is a serious concern in elderly and ICU patients and several providers are involved in the care of these patients.
Appropriate identification and management of refeeding syndrome patients require the involvement of professionals including intensivists, dieticians, pharmacists, nursing staff, and nutritionists. A multidisciplinary team is crucial for the timely diagnosis and treatment of refeeding syndrome patients.
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. BMJ Clinical research ed. Annals of internal medicine. Archives of surgery Chicago, Ill. Mineral and electrolyte metabolism. Current diabetes reports. Cahill GF Jr, Fuel metabolism in starvation. Annual review of nutrition. Helfant RH, Hypokalemia and arrhythmias. The American journal of medicine.
Pediatric nephrology Berlin, Germany. International journal of nephrology and renovascular disease. Lonsdale D, A review of the biochemistry, metabolism and clinical benefits of thiamin e and its derivatives.
Evidence-based complementary and alternative medicine : eCAM. European journal of clinical nutrition. Gastroenterology research and practice. Thomson AD, Mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome. Learn more about this deficiency, hypocalcemia…. Dysphagia refers to a difficulty in swallowing.
Many problems can arise in the muscles and nerves between the mouth and the stomach that might cause…. Hypomagnesemia refers to low levels of magnesium in the blood, defined as less than 1. Hypomagnesemia is linked to calcium and potassium…. Many automatic processes in the body run on small electric currents, and electrolytes provide this charge.
Electrolytes are present throughout the…. What is refeeding? Medically reviewed by Judith Marcin, M. Causes Who is at risk?
Symptoms Risk factors Treatment Recovery Prevention Takeaway Refeeding syndrome can develop when someone who is malnourished begins to eat again. What are the causes of refeeding syndrome? Share on Pinterest Refeeding syndrome can occur when food is reintroduced to a person who is malnourished. Who is at risk? Risk factors. Share on Pinterest A history of alcohol use disorder can put a person at risk for refeeding syndrome. What are the treatment options? Can it be prevented? Share on Pinterest It is important for healthcare professionals to look out for warning signs and treat at-risk patients.
When carbohydrate consumption is significantly reduced, insulin secretion slows. In the absence of carbohydrates, the body turns to stored fats and proteins as sources of energy. Over time, this change can deplete electrolyte stores. Phosphate , an electrolyte that helps your cells convert glucose into energy, is often affected. This causes insulin secretion to increase.
Cells need electrolytes like phosphate to convert glucose to energy, but phosphate is in short supply. This leads to another condition called hypophosphatemia low phosphate.
Hypophosphatemia is a common feature of refeeding syndrome. Other metabolic changes can also occur. These include:. Refeeding syndrome can cause sudden and fatal complications. Symptoms of refeeding syndrome may include:. These symptoms typically appear within 4 days of the start of the refeeding process. As a result, prevention is critical. There are clear risk factors for refeeding syndrome.
You may be at risk if one or more of the following statements apply to you:. You may also be at risk if two or more of the following statements apply to you:. Other factors can also put you at an increased risk of developing refeeding syndrome. You might be at risk if you:.
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