Hypoglycemia associated with refeeding syndrome in a cat

DeAvilla, Marisa D.; Leech, Elizabeth B.

doi:10.1111/vec.12456

Cited by 11 publications

(20 citation statements)

References 19 publications

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“…Magnesium is important in the function of many enzymes and metabolic pathways and magnesium deficiency can impair correction of other deficiencies such as thiamine and calcium. Low serum total magnesium was only detected in one of the cats reported with refeeding syndrome but was not measured in every case . The dog reported here had low measured serum total magnesium at the time of referral following initial refeeding but no obvious clinical consequences of hypomagnesemia.…”

Section: Discussionmentioning

confidence: 65%

“…ATP depletion can cause loss of erythrocyte membrane integrity, cell shape and deformability, and malfunction of the sodium‐potassium pump, potentially resulting in hemolysis . Hypophosphatemia has been a prominent feature of refeeding syndrome in all reported feline cases, and was often associated with hemolysis . Hypophosphatemia was only documented once in this dog after initial refeeding (prompting stopping feeding and referral), but a simultaneous regenerative anemia was noted, suggesting that hemolysis may have occurred.…”

Section: Discussionmentioning

confidence: 84%

“…Refeeding syndrome was also reported in 2 cats resuscitated and fed after being trapped without access to food for 7 to 12 weeks and 1 cat with hepatic lipidosis fed through an esophageal feeding tube following a 4‐week history of decreased appetite and weight loss . All veterinary reports of refeeding syndrome in the literature have been in cats . This case report describes the management of a severely malnourished dog during refeeding, and highlights treatment considerations that may be important in the prevention of refeeding syndrome in such cases.…”

Section: Introductionmentioning

confidence: 92%

“…Hypophosphatemia was reported in 9 chronically malnourished cats after enteral alimentation was initiated . Refeeding syndrome was also reported in 2 cats resuscitated and fed after being trapped without access to food for 7 to 12 weeks and 1 cat with hepatic lipidosis fed through an esophageal feeding tube following a 4‐week history of decreased appetite and weight loss . All veterinary reports of refeeding syndrome in the literature have been in cats .…”

Section: Introductionmentioning

confidence: 99%

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Successful management and recovery following severe prolonged starvation in a dog

Khoo

Taylor

Owens

2019

J Vet Emergen Crit Care

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Objective: To describe the successful management of a dog following a period of prolonged food deprivation.Case Summary: A 7-year-old, intact male Labrador Retriever presented with profound weakness and loss of nearly 50% of his body weight due to severe prolonged starvation after being trapped in a well for 27 days. Electrolyte concentrations were managed with intensive intravenous supplementation during refeeding. The dog's electrolyte abnormalities resolved, wounds healed, and strength returned during the first 3 weeks of treatment. During the next 3 months, body condition score normalized and muscle mass improved.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Successful management and recovery following severe prolonged starvation in a dog

Khoo

Taylor

Owens

2019

J Vet Emergen Crit Care

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“…Although this amount of energy might be insufficient for RFS development, it is conceivable that our glucose dosage was sufficient to promote refeeding hypophosphatemia in light of previous reports of the effects of reintroduction of carbohydrates in this syndrome (22). Some reports have demonstrated RFS in animals ; however, symptoms appeared after several days (23,24). Because of the direct infusion of glucose solution via intravenous administration, we were able to observe hypophosphatemia within one day.…”

Section: Discussionmentioning

confidence: 58%

Hypophosphatemia occurs with insulin administration during refeeding by total parenteral nutrition in rats

et al. 2018

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Refeeding syndrome (RFS) refers to the metabolic and clinical changes that occur with rapid or excessive administration of feeding, whether orally, enterally or parenterally, following a period of relative or absolute starvation (1). RFS is characterized by fatal complications such as heart failure, arrhythmia, respiratory failure and cardiac arrest (2) ; thus, the prevention of RFS is vital. In general, individuals with marasmus or kwashiorkor are at risk for RFS, particularly in cases of greater than 10% weight loss over a couple of months. Furthermore, patients are at risk after prolonged fasting, massive weight loss in chronic alcoholism, prolonged intravenous fluid repletion and anorexia nervosa (3, 4). Currently, this syndrome is common among elderly people with poor nutritional intake due to alcoholism or dementia in the clinical practice.Hypophosphatemia is the hallmark of RFS and is key to its prevention and treatment (5). Further, it is reported to be associated with increased mortality in critically ill patients (6, 7). The mechanism of refeeding hypophosphatemia can be described by the following hypothesis. With the reintroduction of carbohydrates to malnutrition patients, anabolism begins immediately and the body shifts to carbohydrate metabolism from fat catabolism. The increased glucose load, with a corresponding increase in the release of insulin, leads to cellular uptake of glucose, potassium (K), magnesium (Mg), and phosphate (Pi). This shift of electrolytes into the cell causes hypokalemia, hypomagnesemia, and hypophosphatemia (8,9). Patients consistently present with hypophosphatemia, although the other symptoms are not always detected. However, the molecular mechanisms of hypophosphatemia and RFS require elucidation.RFS is more likely to occur after parenteral or enteral feeding (10). In a study of patients that received total parenteral nutrition (TPN), the incidence of hypophosphatemia ranged from 30 -38% when Pi was provided in the solution, to 100% when TPN without Pi was administered (11). The RFS guideline of the National Institute for Health and Clinical Excellence (NICE) in England and Wales recommends that nutritional repletion of energy should be started slowly, and Pi supplementation should be given unlessblood levels are high before refeeding (12). Pi supplementation was reported to reduce the incidence of hypophosphatemia in hospitalized patients receiving TPN (13). Thus, Pi has an important role in RFS.Guidelines on the prevention and treatment of this syndrome are available ; however, cases continue to be seen clinically. One reason why the mechanism of RFS is unknown is the lack of an appropriate animal model. To our knowledge, there are no reports of animal models with hypophosphatemia, making investigation of RFS challenging. Thus, the development of an animal model is vital for the detailed evaluation of RFS as well as clarification of its molecular mechanism. In this study, as a first step toward revealing the mechanism of RFS, we attempted to develop an RFS animal model ...

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Enteral Nutrition and Tube Feeding

Larsen

2023

Applied Veterinary Clinical Nutrition

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Hypoglycemia associated with refeeding syndrome in a cat

Cited by 11 publications

References 19 publications

Successful management and recovery following severe prolonged starvation in a dog

Successful management and recovery following severe prolonged starvation in a dog

Hypophosphatemia occurs with insulin administration during refeeding by total parenteral nutrition in rats

Enteral Nutrition and Tube Feeding

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