Clinical Nutrition Topic of the Day: Refeeding Syndrome

Refeeding syndrome is defined as “biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual”. This occurs when feeding is reintroduced after a long period of starvation, resulting in many negative consequences.

Overview of Refeeding Syndrome

During the starvation state, the body decreases the rate of gluconeogenesis in order to preserve muscle and protein stores. This leads to fat, mineral, electrolyte, and vitamin depletion. Insulin levels are decreased and glucagon levels are increased.

Whenever the body is suddenly “refed” after it had been previously starved and malnourished, the body switches from a catabolic state to an anabolic state. In response to high glucose, insulin levels are increased. This causes an increase in fat, glycogen, and protein synthesis. These many metabolic processes require fluid, sodium, potassium, and magnesium…which had previously already been depleted. Refeeding syndrome also increases metabolic rate and decreases the body’s ability to adequately deliver oxygen to other organs, resulting in many negative consequences (presented below).

Source: Z Stanga, et al. Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment: The refeeding syndrome. European Journal of Clinical Nutrition 62, 687-694 (June 2008)

Clinical Manifestations of Refeeding Syndrome

The Features and Manifestations of Refeeding Syndrome
Source: http://www.hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf

Patients at Risk for Refeeding Syndrome

How Can Dietitians Prevent Refeeding Syndrome??

The key to preventing refeeding syndrome is to begin the feeding, whether enterally or parenterally, slowlythen increase to the goal rate over several days. It is somewhat debated, but the starting calorie range should be somewhere between 15-20 kcal/kg body weight/day.

Source: Mehanna H, et al. Refeeding syndrome–awareness, prevention and management. Head Neck Oncol. 2009 Jan 26;1:4.

Sources:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945646/

http://www.hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf

Mehanna H, Nankivell PC, Moledina J, Travis J. Refeeding syndrome–awareness, prevention and management. Head Neck Oncol. 2009 Jan 26;1:4.

Z Stanga, A Brunner, M Leuenberger, R F Grimble, A Shenkin, S P Allison and D N Lobo. Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment: The refeeding syndrome. European Journal of Clinical Nutrition 62, 687-694 (June 2008)

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