Evaluation of refeeding hypophosphatemia frequency, risk factors, and nutritional status during stem cell transplantation in patients with hematologic malignancy

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review

“…Patients with HMs should be scrutinized closely for risk of refeeding syndrome. [97][98][99] Constant laboratory monitoring (ie, at least once daily) seems mandatory during the initial MNT administration F I G U R E 2 Strategies to optimize enteral nutrition (EN) delivery before during intensive care unit admission. [87][88][89][90][91][92][93][94][95][96] F I G U R E 3 Proposal of a modified algorithm select the feeding route for medical nutrition therapy in patients with hematological malignancies admitted to the ICU.…”

“…| 807 in these patients to monitor for evidence of hypophosphatemia, hypokalemia, or hypomagnesemia and any clinically related complications associated with refeeding syndrome (eg, cardiac failure, muscle weakness, and immune dysfunction). 72,[97][98][99] The increased demand for phosphate in tissues, especially during recovery and anabolism, may exceed supply of adenosine triphosphate, which can affect the normal function and survival of blood cells. 99 Patients may develop hemolysis, thrombocytopenia, and leukocyte dysfunction (ie, reduced granulocyte activity, impaired chemotaxis, and phagocytosis) in the setting of refeeding syndrome.…”

“…Indeed, tissue oxygen release may be diminished because of a leftward shift of the oxyhemoglobin dissociation curve caused by lower 2-3-diphosphoglycerate production in red blood cells. 97,99 Electrolyte abnormalities, especially hypophosphatemia in the setting of refeeding syndrome, represent metabolic alterations that may be associated with worse functional bone marrow recovery during the clinical course of HMs. 100 Thus, careful electrolyte monitoring, particularly phosphate, should be strictly performed daily as MNT is initiated.…”

“…Monitoring 11,30,43,44,[70][71][72][73][74][75][76][77][97][98][99][100][101][102][103][104][105] • Daily calculation of energy and protein requirements to avoid caloric debt and progression or development of sarcopenia • Consider modifying MNT administration when HM-related treatment (eg, chemotherapy), ICU-related complications (eg, sepsis), and HM-related complications (eg, GVHD) that may negatively affect MNT delivery and tolerance • Early detection and correction of electrolyte disturbances, especially hypophosphatemia, hypokalemia, and hypomagnesemia to prevent and treat complications related with dyselectrolytemias, especially refeeding syndrome • Consider also modifying MNT administration aiming for the prevention and treatment of sarcopenia to improve ICU recovery: increase protein supplementation when patient is more stable and active physiotherapy program (eg, resistance exercise training) is being performed • Optimize drugs that may interfere with GI function (eg, opioids, sedatives, vasopressors) and the different strategies to optimize EN delivery during ICU admission (see Figure 2) • Consider initiating as soon as possible supplementary PN when it is not possible to achieve >70% of the nutrition targets by enteral route after applying the different strategies to optimize EN delivery Abbreviations: EN, enteral nutrition; GVHD, graft-vs-host disease HM, hematological malignancy; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; MNT, medical nutrition therapy; NG, nasogastric; PN, parenteral nutrition.…”

“…Refeeding syndrome is associated with laboratory and clinical features that occur when MNT is initiated in patients with malnutrition or at high nutrition risk (eg, after a period of starvation). Patients with HMs should be scrutinized closely for risk of refeeding syndrome 97–99 . Constant laboratory monitoring (ie, at least once daily) seems mandatory during the initial MNT administration in these patients to monitor for evidence of hypophosphatemia, hypokalemia, or hypomagnesemia and any clinically related complications associated with refeeding syndrome (eg, cardiac failure, muscle weakness, and immune dysfunction) 72,97–99 .…”