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Refeeding syndrome

Rachel Nicoll, Michael Y Henein
Essential hypertension, fast heart rate, low heart rate variability, sympathetic nervous system dominance over parasympathetic, arterial stiffness, endothelial dysfunction and poor flow-mediated arterial dilatation are all associated with cardiovascular mortality and morbidity. This review of randomised controlled trials and other studies demonstrates that caloric restriction (CR) is capable of significantly improving all these parameters, normalising blood pressure (BP) and allowing patients to discontinue antihypertensive medication, while never becoming hypotensive...
March 7, 2018: International Journal of Molecular Sciences
R Wirth, R Diekmann, G Janssen, O Fleiter, L Fricke, A Kreilkamp, M K Modreker, C Marburger, S Nels, M Pourhassan, R Schaefer, H-P Willschrei, D Volkert
Refeeding syndrome is a life-threatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Refeeding syndrome can be effectively prevented and treated if its risk factors and pathophysiology are known. The initial measurement of thiamine level and serum electrolytes, including phosphate and magnesium, their supplementation if necessary, and a slow increase in nutritional intake along with close monitoring of serum electrolytes play an important role...
March 2, 2018: Der Internist
M Pourhassan, I Cuvelier, I Gehrke, C Marburger, M K Modreker, D Volkert, H P Willschrei, R Wirth
OBJECTIVES: The incidence of refeeding syndrome (RFS) in older patients is not well-known. The aim of the study was to determine the prevalence of known risk factors for RFS in older individuals during hospitalization at geriatric hospital departments. DESIGN AND SETTING: 342 consecutive older participants (222 females) who admitted at acute geriatric hospital wards were included in a cross-sectional study. We applied the National Institute for Health and Clinical Excellence (NICE) criteria for determining patients at risk of RFS...
2018: Journal of Nutrition, Health & Aging
Indrė Lapinskienė, Gabija Mikulevičienė, Gabija Laubner, Robertas Badaras
Refeeding syndrome, as a life-threatening condition, is well known among severely malnourished or deeply metabolically stressed patients. This case presents an atypical manifestation of the syndrome to a young bodybuilder, whose extreme diet, including 5 months of insufficient nourishment before the sport competition and 6 days of carbohydrates overload afterwards, has led him to a bilateral lower - limb paralysis and drastic homeostatic disturbances. Severe hypokalemia, hypophosphatemia, hypomagnesemia and hyperglycemia with mildly elevated liver enzymes have occurred...
February 2018: Clinical Nutrition ESPEN
Marta Araujo Castro, Clotilde Vázquez Martínez
Refeeding syndrome (RS) is a complex disease that occurs when nutritional support is initiated after a period of starvation. The hallmark feature is the hypophosphataemia, however other biochemical abnormalities like hypokalaemia, hypomagnesaemia, thiamine deficiency and disorder of sodium and fluid balance are common. The incidence of RS is unknown as no universally accepted definition exists, but it is frequently underdiagnosed. RS is a potentially fatal, but preventable, disorder. The identification of patients at risk is crucial to improve their management...
February 12, 2018: Medicina Clínica
Katie Braun, Anne Utech, Maria Eugenia Velez, Renee Walker
BACKGROUND: Studied since the 1940s, refeeding syndrome still has no universal definition, thus making comparison of studies difficult. Negative outcomes (eg, metabolic abnormalities) may occur with the use of specialized nutrition, such as parenteral nutrition (PN). Less than half of medical institutions have a nutrition support team (NST) managing PN. Interdisciplinary team management of PN may reduce negative outcomes of PN. The objective of this study was to show the value of the NST by measuring differences in PN variables, especially electrolyte abnormalities (EAs), before and after NST initiation at a large medical center and to identify factors associated with EAs among adult subjects receiving PN...
February 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Natalie Friedli, Zeno Stanga, Alison Culkin, Martin Crook, Alessandro Laviano, Lubos Sobotka, Reto W Kressig, Jens Kondrup, Beat Mueller, Philipp Schuetz
OBJECTIVES: Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search...
March 2018: Nutrition
Sonia Hammami, Houda Lazreg Aref, Messouda Khalfa, Ines Kochtalli, Mohamed Hammami
BACKGROUND: Refeeding syndrome is a rare and life-threatening pathology with polyvisceral manifestations occurring in severely malnourished patients. It is rarely described in adults with celiac disease. CASE PRESENTATION: We report the case of a 28-year-old Tunisian woman followed up for celiac disease, who did not adhere to the gluten-free diet. She presented to our hospital with celiac crisis manifested by severe diarrhea, and metabolic and electrolyte disturbances...
January 31, 2018: Journal of Medical Case Reports
Kristine W A C Koekkoek, Arthur R H van Zanten
PURPOSE OF REVIEW: The narrative review aims to summarize the relevant studies from the last 2 years and provide contextual information to understand findings. RECENT FINDINGS: Recent ICU studies have provided insight in the pathophysiology and time course of catabolism, anabolic resistance, and metabolic and endocrine derangements interacting with the provision of calories and proteins.Early provision of high protein intake and caloric overfeeding may confer harm...
April 2018: Current Opinion in Anaesthesiology
Federico Miguel Cuesta Triana, Francisco Villazón González, Alejandro Sanz Paris, Juan Ignacio Ramos-Clemente Romero, José Enrique Palacio Abizanda, Rebeca Sanz Barriuso
BACKGROUND: Enteral nutrition (EN) is an effective nutritional intervention for patients at risk of malnutrition or malnourished. However, complications such as gastrointestinal intolerance, hyperglycemia or refeeding syndrome can be triggered by EN. AIM: To investigate the effects of a tube feeding formula (TFF) on patients' nutritional status, biochemical status, bowel habits and safety. METHODOLOGY: Observational, prospective and multicenter study...
October 27, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
Wilhelmina A C Koekkoek, Arthur R H Van Zanten
PURPOSE OF REVIEW: To summarize recent relevant studies regarding refeeding syndrome (RFS) in critically ill patients and provide recommendations for clinical practice. RECENT FINDINGS: Recent knowledge regarding epidemiology of refeeding syndrome among critically ill patients, how to identify ICU patients at risk, and strategies to reduce the potential negative impact on outcome are discussed. SUMMARY: RFS is a potentially fatal acute metabolic derangement that ultimately can result in marked morbidity and even mortality...
December 14, 2017: Current Opinion in Clinical Nutrition and Metabolic Care
Kylie L Matthews, Michelle A Palmer, Sandra M Capra
AIM: Using standardised terminology in acute care has encouraged consistency in patient care and the evaluation of outcomes. As such, the Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) may assist dietitian nutritionists in the delivery of high quality nutrition care worldwide; however, limited research has been conducted examining the consistency and accuracy of its use. We aimed to examine the NCPT that dietitian nutritionists would use to formulate a diagnostic statement relating to refeeding syndrome (RFS)...
November 8, 2017: Nutrition & Dietetics: the Journal of the Dietitians Association of Australia
Aiko Igarashi, Takashi Okuno, Genrei Ohta, Shuko Tokuriki, Yusei Ohshima
Background: Refeeding syndrome is characterized by metabolic disturbance including hypophosphatemia and hypokalemia upon reinstitution of nutrition in severely malnourished patients. Objective: The present study sought to identify the risk factors for the development of refeeding syndrome-like metabolic disturbance in very low birth weight infants. Methods: The correlations of severe hypophosphatemia with the serum levels of potassium and ionized calcium, daily calorie and phosphate intake, and umbilical cord blood flow on ultrasonography were analyzed in 49 very low birth weight infants...
2017: Disease Markers
Maria Teresa Fernández López, Áurea María Gómez Márquez, Laura Casado Vázquez, Susana Alonso Urrutia, María Luisa Bardasco Alonso, María Teresa Rivero Luis, Eva Fernández Pérez, Susana Barreiros Blanco, María Teresa Alves Pérez, José Antonio Mato Mato
BACKGROUND: Up to 30-40% of the patients starting artificial nutritional support develop hypophosphatemia. In general, patients with mild and moderate hypophosphatemia do not have symptoms, but severe hypophosphatemia is the hallmark of refeeding syndrome. AIM: To determine the incidence of hypophosphatemia in not critically ill patients receiving enteral feeding. MATERIAL AND METHODS: Prospective study. We assessed during seven days 181 not critically ill patients started on enteral artificial nutrition support during seven days...
July 28, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
Martin Windpessl, Beate Mayrbaeurl, Christian Baldinger, Gernot Tiefenthaller, Friedrich C Prischl, Manfred Wallner, Josef Thaler
The term refeeding syndrome (RFS) refers to the metabolic perturbations and its attendant complications in subjects who are refed after fasting. The syndrome is characterized by profound shifts of electrolytes and fluids. Its consequences are widespread and sometimes fatal. Patients with malignancies are especially vulnerable due to the presence of multiple comorbidities. We report the course of four patients with malignant or hematological disorders who developed RFS while being treated for their underlying illness...
February 2017: World Journal of Oncology
Toshihiro Tsuruda, Nozomi Shinohara, Miyuki Ogata, Kazuo Kitamura, Hidenobu Ochiai
Transient left ventricular contractile dysfunction (TLVCD) is often observed as a result of stress-related cardiomyopathy; however, recent reports suggest that rhabdomyolysis and eating disorders can also induce the development of TLVCD. We report a 52-year-old malnourished man who developed acute heart failure on day 4 of treatment for rhabdomyolysis. Transthoracic echocardiogram revealed severe hypokinesis at the apical and mid-ventricular segments, except for the basal segments of the left ventricular wall, which recovered within one week...
October 15, 2017: Internal Medicine
J J S Rutten, H Post, G H de Weert-van Oene, V J A Buwalda
Refeeding syndrome (RS) can occur when malnourished patients are reintroduced to carbohydrates. The symptoms are caused by a combination of electrolyte shifts and fluid retention. Symptoms are wide-ranging; some patients may suffer from harmless muscle cramps, others from more severe neurological and cardiological symptoms that can even lead to death. Although alcohol dependence is a risk factor for the development of RS, little attention is being given to this problem in addiction treatment. In this article we report a case of RS that occurred during alcohol detoxification...
2017: Tijdschrift Voor Psychiatrie
Laura E Olthof, W A C Kristine Koekkoek, Coralien van Setten, Johannes C N Kars, Dick van Blokland, Arthur R H van Zanten
BACKGROUND & AIMS: Refeeding syndrome comprises metabolic disturbances that occur after the reintroduction of feeding after prolonged fasting. Standard care consists of correcting fluid and electrolytes imbalances. Energy intake during refeeding syndrome is heavily debated. This study addresses the effect of caloric intake on outcome during the management of refeeding syndrome. METHODS: A retrospective study among critically ill invasive mechanically ventilated patients admitted for >7 days to a medical-surgical ICU...
August 10, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
K L Matthews, S M Capra, M A Palmer
BACKGROUND/OBJECTIVES: Refeeding syndrome (RFS), a life-threatening medical condition, is commonly associated with acute or chronic starvation. While the prevalence of patients at risk of RFS in hospital reportedly ranges from 0 to 80%, the prevalence and types of patients who die as a result of RFS is unknown. We aimed to measure the prevalence rate and examine the case histories of patients who passed away with RFS listed as a cause of death. SUBJECTS/METHODS: Patients were eligible for inclusion provided their death occurred within a Queensland hospital...
January 2018: European Journal of Clinical Nutrition
Yuka Tomabechi, Takeshi Tsuruta, Shinichi Saito, Martin Wabitsch, Kei Sonoyama
Leptin, an adipokine secreted by white adipocytes, is known for its function in regulating food intake and energy expenditure, but the mechanisms regulating its circulating levels is not fully understood. Our previous findings suggest that as yet unidentified humoral factors released from enterocytes are involved. The present study tested glucocorticoids (GCs) as candidate factors. Supplementation of corticosterone and cortisol promoted leptin production in murine adipocytes from the 3T3-L1 cell strain and human adipocytes from the Simpson Golabi-Behmel syndrome (SGBS) cell strain, respectively...
July 25, 2017: Journal of Cell Communication and Signaling
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