Hypokalemia during the early phase of refeeding in patients with cancer

Grasso, Simona A.; Ferro, Yvelise; Migliaccio, Valeria; Mazza, Elisa; Rotundo, Stefania; Pujia, Arturo; Montalcini, Tiziana

doi:10.6061/clinics/2013(11)05

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Skin fold thickness was measured three times at the triceps (TSF) with the GIMA Skinfold Caliper (Gessate, Milan, Italy) [ 23 , 24 ] and the mean was calculated.…”

Section: Methodsmentioning

confidence: 99%

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

et al. 2015

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BackgroundThe association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients.MethodsIn this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed.ResultsAt univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = −0.89), mid-arm muscle circumference (p = 0.050; beta = −1.29), hemoglobin (p = 0.04, beta −1.1) and albumin (p = 0.04, beta −7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ2 test = 6.47).ConclusionAlbumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.

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“…Skin fold thickness was measured three times at the triceps (TSF) with the GIMA Skinfold Caliper (Gessate, Milan, Italy) [ 23 , 24 ] and the mean was calculated.…”

Section: Methodsmentioning

confidence: 99%

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

et al. 2015

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“…Since then, many cases of RFS have been described as a rare, but severe and potentially fatal complication related to re-feeding (either orally, enterally or parenterally) of individuals who have fasted or consumed very few calories over a long period of time [10,11]. Among the diseases or conditions predisposing to malnutrition and consequently to RFS after re-feeding, anorexia nervosa [12][13][14], cancer [15,16], critical illnesses [13,[17][18][19][20], and frailty in the elderly [21][22][23][24][25][26][27] are the most frequently implicated.…”

Section: Introductionmentioning

confidence: 99%

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2–5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.

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“…Regarding mechanisms responsible for hypokalemia, binge–purge behavior and laxative/diuretic abuse are believed to induce hypokalemia [ 3 , 12 ] via gastrointestinal fluid loss and the associated renal loss of potassium [ 13 ]. Other potential mechanisms underlying hypokalemia in patients with anorexia nervosa include severe malnutrition and its associated low potassium intake [ 12 , 14 , 15 ], induction by hypomagnesemia [ 16 , 17 ], and surges in insulin that occur during the refeeding process [ 1 , 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Hypokalemia in patients with anorexia nervosa during refeeding is associated with binge–purge behavior, lower body mass index, and hypoalbuminemia

et al. 2021

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Background Hypokalemia is frequently found in patients with anorexia nervosa and sometimes leads to life-threatening conditions. Although their serum potassium levels are considered to further decrease during refeeding, no previous studies have addressed actual changes in the serum potassium levels and potential mechanisms underlying hypokalemia during the refeeding period of patients with anorexia nervosa. In this study, we investigated factors associated with hypokalemia during refeeding of patients with anorexia nervosa. Methods We recruited 52 independent patients from 89 admissions with anorexia nervosa (body mass index, 13.0 ± 3.3) from the psychiatry unit in Ashikaga Red Cross Hospital during the period from April 2003 to March 2018 and analyzed serum potassium levels at admission. Of the 89 admissions, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators. Results The initial serum potassium level of 3.6 ± 0.9 mg/dl decreased to 3.1 ± 0.7 mg/dl at nadir hypophosphatemia, which was observed an average of 2.5 days after admission. A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge–purge behavior. Similar results were obtained when the analysis included restrictive or binge–purge types as well as the independent patient group. Conclusions Lower body mass index, hypoalbuminemia, and binge–purge behavior might be used as indicators to guide clinical approaches for controlling serum potassium levels in patients with anorexia nervosa during refeeding. Plain English summary Hypokalemia, low levels of serum potassium, in patients with anorexia nervosa sometimes leads to life-threatening conditions. Thus, it is of great importance to predict the risk of hypokalemia in patients with anorexia nervosa during the refeeding period. Our study found that hypokalemia in patients with anorexia nervosa during refeeding is associated with a lower body mass index and hypoalbuminemia (low levels of serum albumin), in addition to binge–purge behavior.

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Hypokalemia during the early phase of refeeding in patients with cancer

Cited by 8 publications

References 18 publications

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

Hypokalemia in patients with anorexia nervosa during refeeding is associated with binge–purge behavior, lower body mass index, and hypoalbuminemia

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