Refeeding Syndrome

A condition of metabolic imbalance that is caused by complications of initially feeding a severely malnourished patient too aggressively. Usually occurring within the first 5 days of refeeding, this syndrome is characterized by WATER-ELECTROLYTE IMBALANCE; GLUCOSE INTOLERANCE; CARDIAC ARRHYTHMIAS; and DIARRHEA.

Also Known As:

Networked: 94 relevant articles (3 outcomes, 5 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Weight Loss (Weight Reduction)
2.	Malnutrition
3.	Hypophosphatemia
4.	Anorexia Nervosa
5.	Hyperglycemia

Experts

1.	Sriram, Krishnan: 2 articles (02/2010 - 03/2009)
2.	Khalidi, Nabil: 2 articles (10/2004 - 09/2004)
3.	Btaiche, Imad F: 2 articles (10/2004 - 09/2004)
4.	Chesher, Douglas: 1 article (12/2015)
5.	Refeeding Syndrome Trial Investigators Group: 1 article (12/2015)
6.	Palmer, M: 1 article (12/2015)
7.	Doig, Gordon S: 1 article (12/2015)
8.	van Zanten, Arthur Raymond Hubert: 1 article (12/2015)
9.	Bellomo, Rinaldo: 1 article (12/2015)
10.	Simpson, Fiona: 1 article (12/2015)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Refeeding Syndrome:

1.	ElectrolytesIBA 12/01/2015 - "Students' and new graduates' identification of refeeding syndrome risk improved when there was consistency between guidelines, electrolytes and dietitians' responses. " 12/01/2015 - "The present study aimed to determine the consistency of students' and newly-graduated dietitians' classification of refeeding syndrome risk, as well as agreement with the application of comparison tools such as the National Institute for Health and Care Excellence guidelines, patients' electrolytes and supplementation, and clinical dietitians previously surveyed. " 12/01/2015 - "Agreement between student dietitians' identification of refeeding syndrome risk with refeeding guidelines, electrolytes and other dietitians: a pilot study." 05/01/2014 - "We recommend that in alcoholics admitted for managed withdrawal, risk of refeeding syndrome appears to be low, and routine testing of repeat electrolytes appears unnecessary. " 11/03/2008 - "Refeeding syndrome is a potentially lethal condition observed in severely malnourished patients due to severe shifts in electrolytes during refeeding. "
2.	PhosphatesIBA 05/15/2003 - "Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor." 05/15/2003 - "Patients with refeeding syndrome and normal renal function received a Phosphates Polyfusor infusion for the treatment of severe hypophosphataemia (< 0.50 mmol/L). " 05/15/2003 - "To assess the effectiveness and safety of 50 mmol intravenous phosphate infusion, given as a 'Phosphates Polyfusor', for the treatment of severe hypophosphataemia in refeeding syndrome. "
3.	Lipase (Acid Lipase)FDA Link 01/01/2013 - "After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. "
4.	AmylasesFDA Link 01/01/2013 - "After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. "
5.	TransaminasesIBA 01/01/2013 - "After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. "
6.	MagnesiumIBA 01/01/2013 - "Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). " 12/01/2010 - "Risk factors for refeeding syndrome did not predict falls in serum phosphate or magnesium." 12/01/2010 - "To evaluate changes in serum magnesium and phosphate over time in hospitalised older patients, examine whether such changes were associated with changes in muscle strength, and assess whether risk factors for refeeding syndrome were associated with falls in serum magnesium and phosphate. " 12/01/2010 - "Changes in serum magnesium and phosphate in older hospitalised patients--correlation with muscle strength and risk factors for refeeding syndrome." 01/01/2013 - "Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. "
7.	PotassiumIBA 01/01/2015 - "Potassium toxicity at low serum potassium levels with refeeding syndrome." 09/01/2011 - "To avoid refeeding syndrome in severely malnourished children, food intake should be increased slowly at first, and phosphate, magnesium, and potassium supplements should be given. " 05/01/2010 - "Serum levels of magnesium, phosphate and potassium were regularly monitored to prevent refeeding syndrome. " 05/01/2006 - "Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome. " 06/01/2010 - "The current findings suggest that use of an HP formula without a proportional increase in its phosphorus and potassium content induces pathology similar to the refeeding syndrome in IUGR piglets."
8.	PhosphorusIBA 01/01/2012 - "No subjects had refeeding syndrome; 20% had low serum phosphorus. " 12/01/2012 - "Phosphorus is an essential substance in our body, and hypophosphataemia (HP) is well-described in rickets, refeeding syndrome, diabetic ketoacidosis (DKA), and in chronic alcohol-abuse. " 01/01/2013 - "We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome). " 05/01/2006 - "Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome. " 06/01/2010 - "The current findings suggest that use of an HP formula without a proportional increase in its phosphorus and potassium content induces pathology similar to the refeeding syndrome in IUGR piglets."
9.	Thiamine (Aneurin)FDA Link 10/14/2015 - "To avoid refeeding syndrome, it is fundamental to find and correct any electrolytic deficiency and to give thiamine before starting a slow and progressive oral, enteral or parenteral refeeding." 05/01/2012 - "No refeeding syndrome was reported (thiamine was added to PN in 34% of patients). " 12/01/2010 - "After proper replacements she was completely normal in the 9th month, and her weight was 55 kg. This patient was interesting for the presenting symptoms (psychosis), and improvement by high doses of thiamine replacement, and also for refeeding syndrome during this period." 07/01/2014 - "In oncologic and malnourished patients, individuals at particular risk for developing refeeding syndrome, in the presence of these biochemical abnormalities, acute thiamine deficiency should be suspected and treated because it promptly responds to thiamine administration." 01/01/2010 - "The child then received treatment appropriate for refeeding syndrome in the form of lower calorie intake with gradual increase, as well as supplementation of electrolytes, thiamine and vitamins and he eventually made a safe recovery. "
10.	Glucose (Dextrose)FDA LinkGeneric 03/01/2011 - "The refeeding syndrome and glucose load." 05/01/2005 - "Clinical characteristics of the HP-group, the time-course and strong association with glucose and food supplementation, are compatible with the refeeding syndrome, described previously in malnourished patients. " 03/01/2008 - "Refeeding syndrome (RFS) is a common, yet underappreciated, constellation of electrolyte derangements that typically occurs in acutely ill, malnourished hospitalised patients who are administered glucose solutions or other forms of intravenous or enteral nutrition. " 05/01/2014 - "Refeeding syndrome may occur after the reintroduction of carbohydrates in chronically malnourished or acutely hypermetabolic patients as a result of a rapid shift to glucose utilization as an energy source. " 03/01/2011 - "A 10-year-old girl with anorexia nervosa developed the refeeding syndrome following cautious reintroduction of nutrition, emphasizing that even with cautious refeeding a shift in fluid, glucose, and electrolytes can still occur, increasing the risk of morbidity and mortality in this ever growing vulnerable group. "

Therapies and Procedures

1.	Nutritional Support (Artificial Feeding) 04/01/2014 - "The treatment was hydration, correction of electrolyte and fluid imbalance, and gradual nutritional support to prevent refeeding syndrome. " 01/01/2012 - "This review summarizes the different therapeutic contexts and objectives, nutritional support, the use of dietary supplements, the role of artificial nutrition, refeeding syndrome, involuntary treatment and nutritional education." 02/01/2010 - "Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. " 03/01/2009 - "In chronically malnourished patients undergoing nutritional support, even hypocaloric feeding should be considered a risk factor for developing refeeding syndrome leading to severe and acute electrolyte fluid-balance and metabolic abnormalities." 07/01/2007 - "Individualised nutritional support in moderately to severely malnourished patients does not produce refeeding syndrome. "
2.	Enteral Nutrition (Feeding, Tube) 03/01/2005 - "This descriptive study examined the effect of an enteral feeding protocol on the typical metabolic consequences seen in refeeding syndrome. " 12/01/2008 - "Electrolyte abnormalities associated with the refeeding syndrome are common, yet underappreciated, and occur typically in acutely ill, malnourished hospitalized patients who are administered intravenous or enteral nutrition. " 12/01/2002 - "A systematic literature review revealed 27 children who developed refeeding syndrome after oral/enteral feeding. " 12/01/2002 - "Refeeding syndrome with enteral nutrition in children: a case report, literature review and clinical guidelines." 05/01/2008 - "From this study we recommend (1) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; (2) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; (3) aggressive nutritional supplementation pre- and postoperatively; and (4) dietitians need to recognize the high risk of refeeding syndrome."
3.	Parenteral Nutrition 10/01/1997 - "Refeeding Syndrome is a frequent entity in malnourished patients submitted to enteral or parenteral nutrition; at least in this study it was of 48%; its presence was followed by a longer hospital stay and a higher mortality rate." 12/01/2013 - "Refeeding syndrome: screening, incidence, and treatment during parenteral nutrition." 10/01/2012 - "Inadequate supply and refeeding syndrome triggered by early aggressive parenteral nutrition were responsible for electrolyte abnormalities." 10/01/2012 - "Refeeding syndrome in a small-for-dates micro-preemie receiving early parenteral nutrition." 11/01/2010 - "The refeeding syndrome can be defined as the metabolic alterations developed by the rapid nutrition repletion (oral, enteral as well as parenteral feeding) of severaly malnourished patients. "
4.	Total Parenteral Nutrition 11/20/2006 - "The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition (TPN), and the solution for the disease. " 04/01/2008 - "Commentary is provided on the pivotal paper by Weinsier and Krumdieck from 1981 describing 2 patients who developed profound and fatal refeeding syndrome following initiation of aggressive total parenteral nutrition. " 04/01/2008 - "Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited." 11/20/2006 - "Enteral refeeding syndrome after long-term total parenteral nutrition." 12/01/2000 - "These deaths resulted from overzealous total parenteral nutrition leading to what was termed the refeeding syndrome. "
5.	Catheters 01/01/2009 - "refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections) can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. " 06/01/2013 - "Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC). "