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: 286 relevant articles (6 outcomes, 18 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypophosphatemia
2.	Heart Failure
3.	Rhabdomyolysis
4.	Respiratory Insufficiency (Respiratory Failure)
5.	Edema (Dropsy)

Experts

1.	Stanga, Zeno: 5 articles (01/2020 - 01/2018)
2.	Friedli, Natalie: 4 articles (01/2020 - 01/2018)
3.	Schuetz, Philipp: 4 articles (01/2020 - 01/2018)
4.	van Zanten, Arthur R H: 4 articles (10/2018 - 04/2017)
5.	Reintam Blaser, Annika: 3 articles (12/2021 - 01/2021)
6.	Reber, Emilie: 3 articles (01/2020 - 11/2019)
7.	Garber, Andrea K: 3 articles (03/2016 - 01/2012)
8.	Golden, Neville H: 3 articles (03/2016 - 04/2004)
9.	Katzman, Debra K: 3 articles (03/2016 - 01/2005)
10.	Kohn, Michael R: 3 articles (03/2016 - 08/2007)

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. " 01/01/2022 - "Management of Severe Hypomagnesemia as the Primary Electrolyte Abnormality with a Delayed Onset of Clinical Signs as a Result of Refeeding Syndrome in a Cat." 04/01/2019 - "In studies with a comparator, no significant differences were found between the EN and oral refeeding cohorts regarding gastrointestinal disturbance, refeeding syndrome, or electrolyte abnormalities. " 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. " 04/01/2013 - "Our study implies that enhanced feeding may induce electrolyte imbalances in VLBW infants, and that deleterious side effects similar to those seen in refeeding syndrome may occur. "
2.	Phosphates (Orthophosphate)IBA 05/15/2003 - "Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor." 12/01/2021 - "Most agreed that the measurement of phosphate levels was not important and that patients should receive full nutrition upon admission, while important risk factors for the development of refeeding syndrome were not recognised or considered. " 01/01/2021 - "In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. " 10/01/2018 - "Of 337 enrolled patients, 124 (36.8%) developed refeeding syndrome and 213 patients (63.2%) maintained normal serum phosphate levels. " 01/01/2016 - "A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome. "
3.	MagnesiumIBA 01/11/2013 - "Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). " 01/11/2013 - "Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. " 01/11/2013 - "Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. " 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. "
4.	PotassiumIBA 01/01/2015 - "Potassium toxicity at low serum potassium levels with 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." 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. " 04/01/2022 - "Randomized controlled trials are needed to further examine the safety and effectiveness of prophylactic supplementation of phosphate, magnesium, and potassium on the prevention of refeeding syndrome, utilizing similar feeding and supplementation protocols."
5.	DexmedetomidineFDA Link 01/01/2022 - "Four interventions showed a significant impact on QoL: Two interventions improved survival and QoL (pravastatin in subarachnoid hemorrhage, dexmedetomidine in elderly patients after noncardiac surgery), while two interventions reduced mortality but negatively influenced QoL (caloric restriction in patients with refeeding syndrome and systematic ICU admission in elderly patients). "
6.	Pravastatin (Pravachol)FDA LinkGeneric 01/01/2022 - "Four interventions showed a significant impact on QoL: Two interventions improved survival and QoL (pravastatin in subarachnoid hemorrhage, dexmedetomidine in elderly patients after noncardiac surgery), while two interventions reduced mortality but negatively influenced QoL (caloric restriction in patients with refeeding syndrome and systematic ICU admission in elderly patients). "
7.	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. "
8.	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. "
9.	Transaminases (Aminotransferases)IBA 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. "
10.	CarbohydratesIBA 01/01/2017 - "Refeeding syndrome (RS) can occur when malnourished patients are reintroduced to carbohydrates. " 01/01/2015 - "The refeeding syndrome may occur during reintroduction of carbohydrates in malnourished patients. " 03/01/2011 - "Discussion focuses on the possible deleterious affects that carbohydrates may have in exacerbating the refeeding syndrome." 05/01/2005 - "Refeeding syndrome is a term that refers to various metabolic abnormalities that may complicate carbohydrate administration in subnourished patient populations. " 04/12/2022 - "This study compared patients who were provided a low carbohydrate diet (40% total energy from carbohydrate) to those who were provided a standard carbohydrate diet (50-60% total energy from carbohydrate) to see if patients from either group were more at risk of developing refeeding syndrome. "

Therapies and Procedures

1.	Nutritional Support (Artificial Feeding) 01/01/2021 - "Pooled data showed a nonsignificant trend toward an increased short-term (≤1 month) mortality in patients developing the refeeding syndrome (odds ratio = 1.27, 95% confidence interval 0.93-1.72), mostly driven by studies in which renutrition was not prescribed and supervised by a nutritional support team (P = .01 at subgroup analysis) and by studies published in previous years (P = .04 at meta-regression). " 02/09/2022 - "Background: refeeding syndrome (RS) is a metabolic complication associated with nutritional support. " 12/01/2021 - "Refeeding syndrome in surgical patients post initiation of artificial feeding, a prospective cohort study in a low-income country." 01/01/2021 - "Inappropriate nutritional support may lead to refeeding syndrome (RFS). " 01/31/2018 - "Nutritional support in patients with celiac crisis should be monitored carefully since the risk of refeeding syndrome is very high with a poor prognosis."
2.	Caloric Restriction 10/01/2018 - "Findings support caloric restriction in refeeding syndrome during critical illness." 04/01/2017 - "The modified NUTrition Risk in the Critically ill score was validated for nutritional risk assessment and identifies patients that benefit from higher nutritional intake; however, caloric restriction decreases mortality in refeeding syndrome. " 12/01/2015 - "Protocolised caloric restriction is a suitable therapeutic option for critically ill adults who develop refeeding syndrome. " 12/01/2015 - "Adult critically ill patients who developed refeeding syndrome within 72 h of commencing nutritional support in the ICU were enrolled and allocated to receive continued standard nutritional support or protocolised caloric restriction. " 05/01/2023 - "Clinical Outcomes of Refeeding Syndrome: A Systematic Review of High vs. Low-Calorie Diets for the Treatment of Anorexia Nervosa and Related Eating Disorders in Children and Adolescents."
3.	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. " 11/01/2022 - "Evaluation of the ASPEN guidelines for refeeding syndrome among hospitalized patients receiving enteral nutrition: A retrospective cohort study." 01/01/2022 - "In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) developed consensus recommendations for identifying patients at risk and with refeeding syndrome. " 12/27/2021 - "After starting enteral nutrition by nasogastric tube, she developed refeeding syndrome. " 12/01/2021 - "The syndrome was confirmed using the King's College criteria and compared with the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria for refeeding syndrome. "
4.	Total Parenteral Nutrition 01/01/2021 - "The incidence of refeeding syndrome in individuals using total parenteral nutrition was high. " 01/01/2021 - "To identify the incidence of refeeding syndrome in hospitalized patients undergoing total parenteral nutrition and factors that may be associated with this condition. " 01/01/2021 - "An unexpectedly high incidence of refeeding syndrome in patients with total parenteral nutrition in a reference university hospital." 01/01/2019 - "Response to Letter re: Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre." 01/01/2019 - "Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre."
5.	Length of Stay 01/01/2022 - "The average length of stay in patients with refeeding syndrome was 25.55 days with a very high heterogeneity between studies. " 01/01/2022 - "The pooled impact of refeeding syndrome on length of stay of 2634 patients in 10 studies was weighted mean difference (WMD) = 2.91 (95% CI, -0.18 - 6.00; P = 0.065) days. " 01/01/2022 - "The pooled length of stay of 2965 patients with refeeding syndrome in 11 studies was 25.55 (95% CI, 20.20-30.90) days. " 04/01/2022 - "Higher calorie diets were associated with decreased length of stay without impacting risk of refeeding syndrome." 01/01/2022 - "Refeeding syndrome affects the length of stay in part of, but not all, patients. "