Refeeding syndrome, an undiagnosed and forgotten potentially fatal condition

Abstract

Refeeding syndrome (RFS) has been well described but is also a frequently forgotten and undiagnosed complication in clinical practice, which, if untreated, may lead to death. Patients who are more prone to developing RFS are those with at least one of the following conditions: BMI <16 kg/m(2), a recent unintentional weight loss >15%, very little nutritional intake for >10 days, and/or low plasma concentrations of potassium, phosphate or magnesium before feeding; and those with at least two of the following conditions: BMI <18.5 kg/m(2), a recent weight loss >10%, very little nutritional intake for >5 day, and/or a history of alcohol abuse or drug use, including insulin, chemotherapy or diuretics. We report here a patient who, after undergoing intestinal resection (short gut syndrome), presented diarrhoea, weight loss and protein-energy malnutrition. After nutritional assessment, the nutritional support team decided to feed the patient by the parenteral route. After 16 h of parenteral nutrition, the patient developed supraventricular tachycardia, hypomagnesaemia and hypocalcaemia, and RFS was diagnosed and managed. After intestinal adaptation, the patient is currently able to maintain his nutritional status with nutrition therapy by the oral route.

MARSIPAN and the deadly triad: management of malnourished patients

“…It is characterised by rapid fluid and electrolyte shifts causing pathophysiological consequences in multi-organ systems 3 4. Hypophosphataemia is the classic hallmark of refeeding syndrome but hypokalaemia, hypomagnesaemia and hyponatraemia are also common 3 4.…”

Vitamins During Cycles of Intermittent Parenteral Nutrition

“…In 2009, we reported the case of a 51-year-old patient with short bowel syndrome who developed refeeding syndrome after receiving parenteral nutrition (Machado et al 2009). The patient had a postsurgical short bowel of 70 cm (27.56 in.)…”

Hypocalcemia and tachycardia induced cardiomyopathy

“…It is not possible to apply any Western tool directly to our children due to different social and educational structure and the norms will vary. The SLD battery test developed and validated by National Institute of Mental Health and Neurosciences (NIMHANS) [2], does not have proper norms. Moreover the tool does not cover the cognitive aspect.…”

“…Both hypocalcemia and hypomagnesemia have been reported as causes of arrhythmias in children as well adults [2,3]. Since this child had two such episodes, he also needs to undergo electrophysiological study to look for any conduction pathway defect, which is rare but a important cause to look for in patients with repeated arrhythmias.…”