Refeeding syndrome—diagnostic challenges and the potential of clinical decision support systems

Heuft, Lara; Voigt, Jenny; Selig, Lars; Stümvoll, Michael; Schlögl, Haiko; Kaiser, Thorsten

doi:10.3238/arztebl.m2022.0381

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…During feasibility testing, the physician in charge was additionally informed about detected patients by telephone by the study physician (Figure 1). Part of the prospectively assessed data was already published in a review paper about the diagnostic potential that CDSS applications yield in RFS recognition improvement [15]. The study was approved by the Ethics Committee of the Medical Faculty of the University of Leipzig (No.…”

Section: Methodsmentioning

confidence: 99%

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Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

Heuft,

Voigt,

Selig

et al. 2023

Nutrients

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Background: The refeeding syndrome (RFS) is an oftentimes-unrecognized complication of reintroducing nutrition in malnourished patients that can lead to fatal cardiovascular failure. We hypothesized that a clinical decision support system (CDSS) can improve RFS recognition and management. Methods: We developed an algorithm from current diagnostic criteria for RFS detection, tested the algorithm on a retrospective dataset and combined the final algorithm with therapy and referral recommendations in a knowledge-based CDSS. The CDSS integration into clinical practice was prospectively investigated for six months. Results: The utilization of the RFS-CDSS lead to RFS diagnosis in 13 out of 21 detected cases (62%). It improved patient-related care and documentation, e.g., RFS-specific coding (E87.7), increased from once coded in 30 month in the retrospective cohort to four times in six months in the prospective cohort and doubled the rate of nutrition referrals in true positive patients (retrospective referrals in true positive patients 33% vs. prospective referrals in true positive patients 71%). Conclusion: CDSS-facilitated RFS diagnosis is possible and improves RFS recognition. This effect and its impact on patient-related outcomes needs to be further investigated in a large randomized-controlled trial.

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Section: Methodsmentioning

confidence: 99%

“…yield in RFS recognition improvement [15]. The study was approved by the Ethics Committee of the Medical Faculty of the University of Leipzig (No.…”

Section: Methodsmentioning

confidence: 99%

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

Heuft,

Voigt,

Selig

et al. 2023

Nutrients

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“…Observing the Burgundy famine, Glaber wrote in his Latin book, Historianum Libri Quinque , of the affected population: “even when they received food, they became distended and died immediately.” 9 Glaber’s description could be attributed to heart failure or hunger edema; these and sudden death upon refeeding are recognized clinical features of refeeding syndrome. 5 , 10 , 11 …”

Section: Refeeding In Ancient Historymentioning

confidence: 99%

“…9 Glaber's description could be attributed to heart failure or hunger edema; these and sudden death upon refeeding are recognized clinical features of refeeding syndrome. 5,10,11 The first medical description of what may well be refeeding syndrome was by the Florentine physician Antonio di Paolo Benivieni (born in 1443), in a book published in 1507, some 5 years after his death. Of noble origin, he became the physician to the famous families in Renaissance Florence, including the first three well-known Medici, i.e.…”

Section: Refeeding In Ancient Historymentioning

confidence: 99%

“…Today, refeeding syndrome is recognized as a condition that can occur following refeeding in malnourished individuals who have experienced no food intake or a pronounced reduction of food intake for at least five days. 5 Clinically, it is diagnosed by the onset of hypophosphatemia within 2–5 days of refeeding and is accompanied by hypokalemia and/or hypomagnesemia. This electrolyte imbalance can lead to central and peripheral edema, as well as complications affecting the neuromuscular, cardiac, and central nervous systems, including tachycardia, impaired cognition, and ultimately death.…”

Section: Introductionmentioning

confidence: 99%

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One Page in the History of Starvation and Refeeding

Hemstreet,

Weisz

2024

Rambam Maimonides Med J

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There is a long history of starvation, including reports dated back to antiquity. Despite exceptional scientific developments, starvation still exists today. The medical aspects of starvation were well established in the twentieth century, particularly following studies related to the 1943–1944 Bengal famine in India and starved prisoners of war and survivors of World War 2. The refeeding of the starved victims provided disappointing results. Nevertheless, those studies eventually led to the development of a new branch of research in medicine and to the definition of what is now known as refeeding syndrome. This paper briefly reviews the history and groundwork that led to today’s understanding of starvation and refeeding, with a particular emphasis on the observations from studies on starved Holocaust survivors and prisoners of war after World War 2. The relevance of these studies for modern times is briefly discussed.

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Severe Hypophosphatemia After Ferric Carboxymaltose Infusion: A Case Report

Arranz-Pasqual,

Torrent-Rodríguez,

Miana-Mena

et al. 2024

Hosp Pharm

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Ferric carboxymaltose (FCM) allows for rapid and total correction of iron deficiency with a lower risk of hypersensitivity reactions compared to other IV iron preparations. However, FCM is associated with potentially serious adverse events, including hypophosphatemia, following the infusion. The mechanism behind FCM-induced hypophosphatemia is not well understood, but pre-existing risk factors can increase the likelihood of severe and persistent hypophosphatemia. We report a clinical case of a male patient who developed severe hypophosphatemia (1.0 mg/dL) after administration of FCM for the treatment of post-cardiotomy normocytic anemia. He required hospital admission and 16 weeks of phosphorous supplementation.

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Refeeding syndrome—diagnostic challenges and the potential of clinical decision support systems

Cited by 8 publications

References 35 publications

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

One Page in the History of Starvation and Refeeding

Severe Hypophosphatemia After Ferric Carboxymaltose Infusion: A Case Report

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