Refeeding syndrome

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Refeeding syndrome
Unintentional weight loss
  • Low levels of potassium, phosphate, or magnesium before eating
  • Alcohol use disorder
  • Some types of medications[1]
  • : 37–38 

    Refeeding syndrome is a

    malnourished, or metabolically stressed because of severe illness. When too much food or liquid nutrition supplement is eaten during the initial four to seven days following a malnutrition event, the production of glycogen, fat and protein in cells may cause low serum concentrations of potassium, magnesium and phosphate.[2][3] The electrolyte
    disturbances may cause neurologic, pulmonary, cardiac, neuromuscular, and hematologic symptoms—many of which, if severe enough, may result in death.

    Cause

    Any individual who has had a negligible nutrient intake for many consecutive days and/or is metabolically stressed from a critical illness or major surgery is at risk of refeeding syndrome. Refeeding syndrome usually occurs within four days of starting to re-feed. Patients can develop fluid and electrolyte imbalance, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.[citation needed]

    During

    amino acids from protein as the main energy sources. The spleen decreases its rate of red blood cell breakdown thus conserving red blood cells. Many intracellular minerals become severely depleted during this period, although serum levels remain normal. Importantly, insulin secretion is suppressed in this fasting state, and glucagon secretion is increased.[2]

    During refeeding, insulin secretion resumes in response to increased

    ]

    Clinical situations

    The syndrome can occur at the beginning of treatment for eating disorders when patients have an increase in calorie intake and can be fatal. It can also occur when someone does not eat for several days at a time usually beginning after 4–5 days with no food. [4] It can also occur after the onset of a severe illness or major surgery. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is increased which strains the respiratory system and can make weaning from ventilation more difficult.[citation needed]

    Diagnosis

    Refeeding syndrome can be fatal if not recognized and treated properly. The electrolyte disturbances of the refeeding syndrome can occur within the first few days of refeeding. Close monitoring of blood biochemistry is therefore necessary in the early refeeding period.[citation needed]

    Treatment

    In critically ill patients admitted to an

    vitamin B complex (strong) and a multivitamin and mineral preparation are strongly recommended. Blood biochemistry should be monitored regularly until it is stable. Although clinical trials are lacking in patients other than those admitted to intensive care, it is commonly recommended that energy intake should remain lower than that normally required for the first 3–5 days of treatment of refeeding syndrome for all patients.[1]
    : 1.4.8 

    History

    In his 5th century

    AD described classic symptoms of the syndrome among survivors of the siege of Jerusalem. He described the death of those who overindulged in food after the famine, whereas those who ate at a more restrained pace survived.[6] Shincho koki chronicle describes similar outcome when starved soldiers were fed after surrender at the siege of Tottori castle on October 25, 1581.[7]

    There were numerous cases of refeeding syndrome in the Siege of Leningrad during World War II, with Soviet civilians trapped in the city having become malnourished due to the German blockade.[8]

    A common error, repeated in multiple papers, is that "The syndrome was first described after World War II in Americans who, held by the

    prisoners of war, had become malnourished during captivity and who were then released to the care of United States personnel in the Philippines."[9]
    However, closer inspection of the 1951 paper by Schnitker reveals the prisoners under study were not American POWs but Japanese soldiers who, already malnourished, surrendered in the Philippines during 1945, after the war was over.[citation needed]

    Refeeding syndrome has also been documented among survivors of the Ebensee concentration camp upon their liberation by the United States Army in May 1945. After liberation, the inmates were fed rich soup; the stomachs of a few presumably could not handle the sudden caloric intake and digestion, and they died.[10][11]

    It is difficult to ascertain when the syndrome was first discovered and named, but it is likely the associated electrolyte disturbances were identified perhaps in Holland, the Netherlands during the so-called Hunger Winter, spanning the closing months of World War II.[12]

    See also

    References

    1. ^ a b "Evidence — Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition — Guidance". National Institute for Health and Care Excellence (NICE). 22 February 2006 [Updated 4 August 2017]. Web page with link to full guideline CG32.
    2. ^
      PMID 18583681
      .
    3. ^ .
    4. .
    5. ^ Hippocrates of Kos. De Carnibus. 5th century BCE.
    6. ^ The Wars of the Jews by Flavius Josephus. October 2001. p. book V, chapter XIII, paragraph 4. Retrieved 2018-05-22 – via www.gutenberg.org.
    7. ^ "Researchers play detective to track earliest case of medical malady | The Asahi Shimbun: Breaking News, Japan News and Analysis". The Asahi Shimbun. Retrieved 2024-01-31.
    8. PMID 21686764
      .
    9. .
    10. ^ Persinger, Robert B. "Remembering Ebensee 1945 Robert B. Persinger, May 6th 2005". Memorial Ebensee. Archived from the original on 7 October 2011.
    11. ^ Nawyn, Kathleen J. "The Liberation of the Ebensee Concentration Camp, May 1945". history.army.mil. U.S. Army Center of Military History. Retrieved 1 October 2018.
    12. .

    Bibliography

    External links