Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are
starvedStarvation is a severe reduction in vitamin, nutrient, and energy intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage, and eventually death...
or severely malnourished.
Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described after the Second World War in prisoners of war taken by Japan.
Refeeding syndrome usually occurs within four days of starting to feed.
Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are
starvedStarvation is a severe reduction in vitamin, nutrient, and energy intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage, and eventually death...
or severely malnourished.
Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described after the Second World War in prisoners of war taken by Japan.
Syndrome
Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and
electrolyteIn chemistry, an electrolyte is any substance containing free ions that behaves as an electrically conductive medium, usually when in a solution...
disorders, especially
hypophosphatemiaHypophosphatemia is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood. The condition has many causes, but is most commonly seen when malnourished patients are given large amounts of carbohydrates, which creates a high phosphorus demand by cells,...
, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. Most effects result from a sudden shift from fat to
carbohydrate metabolismCarbohydrate metabolism denotes the various biochemical processes responsible for the formation, breakdown and interconversion of carbohydrates in living organisms....
and a sudden increase in
insulinInsulin is a hormone that has extensive effects on metabolism and other body functions, such as vascular compliance. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle, and stopping use of fat as an energy...
levels after refeeding which leads to increased cellular uptake of
phosphateA phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...
. Refeeding increases the
basal metabolic rateBasal metabolic rate , and the closely related resting metabolic rate , is the amount of energy expended while at rest in a [neutrally temperate environment, in the post-absorptive state...
. Intracellular movement of electrolytes occurs along with a fall in the
serumIn blood, the serum is the component that is neither a blood cell nor a clotting factor; it is the blood plasma with the fibrinogens removed. Serum includes all proteins not used in blood clotting and all the electrolytes, antibodies, antigens, hormones, and any exogenous substances .The study of...
electrolytes including
phosphateA phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...
,
potassiumPotassium is the chemical element with the symbol K , atomic number 19, and atomic mass 39.0983. Potassium was first isolated from potash...
,
magnesiumMagnesium is a chemical element with the symbol Mg, atomic number 12 and common oxidation number +2. It is an alkaline earth metal and the eighth most abundant element in the earth's crust by mass, although ninth in the Universe as a whole...
,
glucoseGlucose , a monosaccharide also known as - grape sugar, blood sugar, or corn sugar, is a very important carbohydrate in biology. The living cell uses it as a source of energy and metabolic intermediate...
, and
thiamineThiamine or thiamin, sometimes called aneurin, is a water-soluble vitamin of the B complex , whose phosphate derivatives are involved in many cellular processes. The best characterized form is thiamine diphosphate , a coenzyme in the catabolism of sugars and amino acids...
. Significant risks arising from refeeding syndrome include confusion,
comaIn medicine, a coma is a profound state of unconsciousness. A comatose person cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions....
, convulsions, and death.
This syndrome can occur at the beginning of treatment for
anorexia nervosaAnorexia nervosa is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight...
when patients are reintroduced to a healthy diet.
The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is also increased which strains the respiratory system and can make weaning from ventilation more difficult.
Treatment
Refeeding syndrome can be fatal if not recognized and treated properly. If
potassiumPotassium is the chemical element with the symbol K , atomic number 19, and atomic mass 39.0983. Potassium was first isolated from potash...
,
phosphateA phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...
or
magnesiumMagnesium is a chemical element with the symbol Mg, atomic number 12 and common oxidation number +2. It is an alkaline earth metal and the eighth most abundant element in the earth's crust by mass, although ninth in the Universe as a whole...
are low then this should be corrected. Prescribing
thiamineThiamine or thiamin, sometimes called aneurin, is a water-soluble vitamin of the B complex , whose phosphate derivatives are involved in many cellular processes. The best characterized form is thiamine diphosphate , a coenzyme in the catabolism of sugars and amino acids...
, vitamin B complex (strong) and a
multivitaminA multivitamin is a preparation intended to supplement a human diet with vitamins, dietary minerals and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids and injectable formulations...
and mineral is recommended. Biochemistry should be monitored regularly until it is stable.
General references
- Shils, M.E., Shike, M., Ross, A.C., Caballero, B. & Cousins, R.J. (2006). Modern nutrition in health and disease, 10th ed. Lippincott, Williams & Wilkins. Baltimore, MD.
- Mahan, L.K. & Escott-Stump, S.E. (2004) Krause’s Food, Nutrition, & Diet Therapy, 11th ed. Saunders, Philadelphia, PA.