Management of patients during hunger strike and refeeding phase

Eichelberger, Markus; Joray, Maya Lucia; Perrig, Martin; Bodmer, Michael; Stanga, Zeno

doi:10.1016/j.nut.2014.04.007

Cited by 21 publications

(21 citation statements)

References 16 publications

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“…Although the majority had worked with a patient with RFS, and every respondent reported seeing a patient at risk of RFS at least once per year in Project one, respondents from half of the countries interviewed in Project two reported no experience with treating patients with RFS, despite working in acute care. This variability between respondents having treated a patient with RFS versus those having never treated one is to be expected based on the more accurate prevalence rates of 0–2% . These results provide further evidence that the findings from Project one are not generalisable.…”

Section: Discussionmentioning

confidence: 59%

“…These results differ considerably from studies examining the prevalence of RFS using the Rio et al . diagnostic criteria, with rates of 0–2% . Studies with similar RFS prevalence rates (>50%) used decreases in serum electrolyte values to identify RFS.…”

Section: Discussionmentioning

confidence: 99%

“…These results differ considerably from studies examining the prevalence of RFS using the Rio et al 3 diagnostic criteria, with rates of 0-2%. [3][4][5][6][7] Studies with similar RFS prevalence rates (>50%) [19][20][21] used decreases in serum electrolyte values to identify RFS. This practice was also evident in responses from Project two, where decreases in serum electrolyte values was used as the primary definition of RFS by respondents from six countries.…”

Section: Discussionmentioning

confidence: 99%

“…have proposed that a diagnosis should only be made when there is development of a minimum of one severely low serum electrolyte, with oedema, and a severe disturbance to organ function. Using Rio et al .’s method, 0–2% of examined hospital populations have developed RFS, whereas studies that have focused solely on electrolyte imbalances have prevalence figures of up to 80% …”

Section: Introductionmentioning

confidence: 99%

“…2 However, Rio et al 3 have proposed that a diagnosis should only be made when there is development of a minimum of one severely low serum electrolyte, with oedema, and a severe disturbance to organ function. Using Rio et al's 3 method, 0-2% of examined hospital populations have developed RFS, [3][4][5][6][7] whereas studies that have focused solely on electrolyte imbalances have prevalence figures of up to 80%. 2 With the diagnoses of RFS and prevalence rates varying across studies, effective preventative and identification methods are difficult to establish.…”

Section: Introductionmentioning

confidence: 99%

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Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Matthews

Palmer

Capra

2018

Nutrition & Dietetics

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Matthews

Palmer

Capra

2018

Nutrition & Dietetics

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Evaluation of the ASPEN guidelines for refeeding syndrome among hospitalized patients receiving enteral nutrition: A retrospective cohort study

Adika

Jia

et al. 2022

J Parenter Enteral Nutr

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Background Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. This study sought to (1) determine whether RFS, as operationalized in the 2020 American Society for Parenteral and Enteral Nutrition (ASPEN) guideline definition, is associated with adverse clinical outcomes and (2) identify key risk factors for RFS. Methods In this retrospective cohort study, adults hospitalized from 2015 to 2019 were included if they were ordered for enteral feeding during hospitalization. Data were collected for up to 30 days, and RFS was operationalized as per the ASPEN 2020 guidelines as a ≥10% (corresponding to mild RFS), ≥25% (moderate), and ≥50% (severe) decline in prefeeding serum phosphorus, magnesium, or potassium. The mortality associated with RFS was assessed, and risk factors for RFS were identified using multivariable logistic regression modeling. Results Of 3854 participants, 3480 (90%) developed mild RFS. Thirty‐day mortality was higher in those without mild RFS (24%) than in those with mild RFS (18%) (P < 0.01). When RFS was reoperationalized as a 50% decline in electrolytes, 25% of patients developed RFS with a 20% 30‐day mortality. Risk factors for development of RFS included renal failure, elevated creatinine, and low platelets; additionally, prefeeding serum phosphorus level was strongly associated with development of RFS (adjusted odds ratio, 6.09; 95% confidence interval, 4.95–7.49 for those in the highest tertile of prefeeding phosphorus compared with the lowest). Conclusion The ASPEN operationalization of RFS as a decline in baseline electrolyte values was not associated with death. Prefeeding serum phosphorus level strongly predicted severe RFS.

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Systematic Review of Energy Initiation Rates and Refeeding Syndrome Outcomes

2020

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The limited, low‐level evidence available on refeeding syndrome (RFS) is likely a result of there being no universally accepted definition of RFS. Cautious feeding is typically recommended to prevent RFS‐related adverse outcomes; however, these recommendations are outdated. This systematic review aimed to summarize the RFS literature, describe feeding methods used, and determine whether higher or lower energy rates at commencement of feeding were associated with RFS or RFS‐related adverse outcomes. Databases were searched for interventional and observational studies examining feeding and RFS‐related adverse events in adult patients. Data extracted included study design, participant descriptions, energy intake, and incidence of RFS‐related adverse outcomes. Studies were compared based on assertive (>20 kcal/kg/d) or conservative (≤20 kcal/kg/d) feeding initiation rates. Of 2803 abstracts, 24 studies were included (1 randomized control trial, 23 observational studies). Fifteen studies were classified as assertive. Feeding methods varied greatly, making interpretations difficult. Incidence of hypophosphatemia varied widely and was reported at rates of up to 74% for assertive studies and 72% for conservative studies. Similarly, diagnosed RFS was reported at rates of up to 20% for both types of studies. Time to achieve goal feeding rate appeared to have no influence on incidence of RFS‐related adverse outcomes. No consensus was found regarding the best method of feeding, energy initiation, or the time to achieve goal feeding rate that minimizes risk of RFS. There is currently limited evidence to suggest that higher‐energy feeding initiation rates have detrimental impacts on those at risk of RFS; however, further research is necessary.

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Management of patients during hunger strike and refeeding phase

Cited by 21 publications

References 16 publications

Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Dietitians’ opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice

Evaluation of the ASPEN guidelines for refeeding syndrome among hospitalized patients receiving enteral nutrition: A retrospective cohort study

Systematic Review of Energy Initiation Rates and Refeeding Syndrome Outcomes

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