Changes in serum magnesium and phosphate in older hospitalised patients — Correlation with muscle strength and risk factors for refeeding syndrome

Henderson, Samuel T.; Boyce, Frederick Fitzherbert; Sumukadas, Deepa; Witham, Miles D.

doi:10.1007/s12603-010-0261-0

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…The incidence of hypophosphatemia in geriatric facilities is reported to range from 14% to 37%. 10 , 30 In a series of patients with gastrointestinal fistula, 3% experienced hypophosphatemia, and in postoperative patients the incidence was 44%. 31 , 32 In patients with hepatic resection, the reported incidence of hypophosphatemia was 100% 33 .…”

Section: Methodsmentioning

confidence: 99%

Refeeding Syndrome or Refeeding Hypophosphatemia

Skipper¹

2012

Nut in Clin Prac

135

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Nutrition support clinicians refer to the abnormalities in laboratory data and changes in clinical signs and symptoms that follow refeeding of starved or malnourished patients as refeeding syndrome. Theoretical descriptions of refeeding syndrome include a complex and extensive list of changes, such as hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, and vitamin deficiency--all of which are accompanied by clinical signs and symptoms. In practice, clinicians see asymptomatic refeeding hypophosphatemia more often than a full-blown syndrome with multiple laboratory and clinical abnormalities. Confusion results because there is no widely accepted or uniformly applied set of defining characteristics for diagnosing refeeding syndrome. To gain insight into the clinical characteristics of refeeding syndrome described in the literature, a systematic review of reported cases and case series was conducted. Since 2000, 20 authors described 27 cases that contained sufficient data for review. Hypophosphatemia occurred in 26 patients (96%). While 19 patients (71%) experienced at least 1 other laboratory abnormality, only 14 (51%) exhibited a consistent pattern of abnormally low phosphorus and magnesium levels. Seven patients had hypocalcemia (26%), and hyponatremia was reported in 3 patients (11%). There were no reports of hyperglycemia. Mean data reported in case series containing data from 63 patients showed that hypophosphatemia was a consistent finding but that other abnormalities were not consistently identified. Findings suggest that refeeding hypophosphatemia is not accompanied by a consistent pattern of biochemical or clinical abnormalities among case reports or case series of patients reported to have refeeding syndrome.

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Section: Methodsmentioning

confidence: 99%

Refeeding Syndrome or Refeeding Hypophosphatemia

Skipper¹

2012

Nut in Clin Prac

135

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“…Furthermore, low prealbumin or albumin concentration [3,[37][38][39], use of enteral nutrition [3,36,40], and higher amounts of nutritional intake during nutritional therapy [8,31,41] were found to be risk factors. However, some studies did not find that these factors predicted RFS, although some of the studies were small in size with risk for type II errors [37,42,43].…”

Section: Clinical Manifestations Of Rfsmentioning

confidence: 99%

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

et al. 2018

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“…Various studies and guidelines have shown a beneficial effect of starting energy intake at a lower rate than generally used, in order to prevent RFS in patients at high risk [12,16,23]. Based on a patient's individual risk for RFS, energy supply should be initiated at lower levels, starting with an initial amount of 5-15 kcal/kg/day, and increased stepwise depending on the laboratory parameters and clinical situation of the patient [8,19,20,23,52,61,62]. The full energy requirements should be met within 5 to 10 days, depending on the prior risk stratification, using a common nutritional macronutrients composition of 40-60% carbohydrates, 30-40% fats, and 15-20% proteins [12].…”

Section: Macronutrientsmentioning

confidence: 99%

Management of Refeeding Syndrome in Medical Inpatients

Reber

Friedli

Vasiloglou

et al. 2019

JCM

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Refeeding syndrome (RFS) is the metabolic response to the switch from starvation to a fed state in the initial phase of nutritional therapy in patients who are severely malnourished or metabolically stressed due to severe illness. It is characterized by increased serum glucose, electrolyte disturbances (particularly hypophosphatemia, hypokalemia, and hypomagnesemia), vitamin depletion (especially vitamin B1 thiamine), fluid imbalance, and salt retention, with resulting impaired organ function and cardiac arrhythmias. The awareness of the medical and nursing staff is often too low in clinical practice, leading to under-diagnosis of this complication, which often has an unspecific clinical presentation. This review provides important insights into the RFS, practical recommendations for the management of RFS in the medical inpatient population (excluding eating disorders) based on consensus opinion and on current evidence from clinical studies, including risk stratification, prevention, diagnosis, and management and monitoring of nutritional and fluid therapy.confirmed RFS have significant mortality rates and increased non-elective hospital readmission, thus confirming the negative effect of RFS on clinical outcome [5,6].Nutritional treatment is a central aspect of modern multimodal inpatient therapy. It aims to reduce complications and mortality rates, and to improve patients' quality of life and autonomy [5,7]. Even though well tolerated, nutritional treatment has a potential risk of complications, including RFS, which is an exacerbated response to the metabolic change from a starvation to a fed state as a consequence of large amount of food in the replenishment phase. RFS is characterized by an imbalance of electrolytes (mainly phosphate, potassium, and magnesium), vitamin disturbances (e.g., vitamin B1 thiamine deficiency), and fluid imbalances, as well as limited organ functions, in some cases leading to mortality [8][9][10][11][12]. This article highlights, discusses, and reviews RFS in medical inpatients (excluding patients with eating disorders) in terms of pathophysiological aspects, preventive measures, clinical manifestations, risk evaluation, diagnostic procedures, and treatment methods.

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Changes in serum magnesium and phosphate in older hospitalised patients — Correlation with muscle strength and risk factors for refeeding syndrome

Abstract: Changes in serum magnesium and phosphate levels do not correlate with changes in muscle strength in older hospitalised patients. Risk factors for refeeding syndrome did not predict falls in serum phosphate or magnesium.

Cited by 14 publications

References 17 publications

Refeeding Syndrome or Refeeding Hypophosphatemia

Refeeding Syndrome or Refeeding Hypophosphatemia

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

Management of Refeeding Syndrome in Medical Inpatients

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