Refeeding syndrome: update and clinical advice for prevention, diagnosis and treatment

Abstract

Purpose of review The aim of this review is to provide a brief overview of the refeeding syndrome, to discuss more recent advice on diagnosis and treatment, and to raise awareness of this still poorly understood metabolic condition. Recent findings To date, evidence regarding the refeeding syndrome has been very limited. A number of reviews and case reports exist, but only a few are randomized trials. Recently, it has been shown that the vast majority of physicians are unaware of this metabolic condition. Precise guidelines for diagnosis and treatment of this syndrome were lacking for a long time. Now, a consensus statement is available, providing guidance from experts in the field on the management of patients at increased risk of refeeding syndrome (RFS) receiving nutritional therapy. Summary Due to the increased use of nutritional therapy in inpatient settings, physicians should be aware of possible side effects, particularly in connection with the refeeding syndrome. In this context, every patient should undergo a risk assessment for refeeding syndrome and stratification before starting nutritional therapy. For patients at high risk, nutritional support should be administered with adapted energy and fluid support during the replenishment phase. In addition, the occurrence of RFS during nutritional therapy must be continuously evaluated, and appropriate steps taken if necessary.

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

“…In the presence of severe underweight or weight loss, prolonged fasting period, and/or low electrolyte concentrations, the risk of RFS is particularly high [30]. In 2006, the National Institute for Health and Clinical Excellence (NICE) guidelines [48] reported the risk factors to identify people at low or high risk for RSF.…”

“…Owing to the risk of fluid overload, sodium and hydration should be provided cautiously, until the patient is metabolically stable [38]. In [30].…”

“…Furthermore, the lack of a clear definition accounts for the difficulty of diagnosis and uncertainties in treatment [2,29]. Therefore, the RFS is a potentially serious condition, often overlooked by many physicians [30]. This is of particular concern because of the high prevalence of hospital malnutrition often underestimated even in the internal medicine wards [31,32].…”

Patients with enteral nutrition at risk of refeeding syndrome show electrolyte abnormalities at admission in the Emergency Department

“…It is characterized by an imbalance of electrolytes, mainly phosphate, potassium, magnesium, and calcium, and by vitamin disturbances, which can lead to impaired organ functioning (2,3). Data from the literature suggest a tendency to high mortality in this population, especially among malnourished, older, HIV, and critically ill patients (2,4,5).…”

“…RFS incidence largely ranges from 0 % to 80 % according to the definition used and the population studied (2). Clinical, biochemical, and nutritional criteria allow early identification of the risk for RFS, and considering that electrolyte shifts occur in the first 3 days after NT initiation, it is recommended to monitor electrolytes during this period (1,3,4,6). This metabolic condition should be screened and monitored closely, although some studies have suggested that health professionals may be unaware of RFS (3,7).…”