Refeeding syndrome

Hearing, Stephen

doi:10.1136/bmj.328.7445.908

Cited by 126 publications

(91 citation statements)

References 8 publications

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“…Refeeding syndrome is a condition that results from overprovision of food to a malnourished individual; it is due to severe electrolyte and water imbalance following reintroduction of food and manifests within a few days of starting feeding. 7,8 Fluid intolerance, hypophosphataemia, hypomagnesaemia, hypokalaemia and hyperglycaemia are common in patients with RFS, with clinical consequences including heart failure, respiratory failure, seizures and sudden death. 9 However, RFS is often unrecognised, because the signs and symptoms are non-specific and biochemical changes may be minimal.…”

Section: Commentmentioning

confidence: 99%

Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway

2013

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-This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.KEY WORDS: Liverpool Care Pathway, dying, elderly, overhydration, refeeding syndrome 'If a convalescent while taking nourishment remains weak, it is a sign that the body is being overnourished'Hippocratic Aphorism, 4th century BC

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Section: Commentmentioning

confidence: 99%

Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway

2013

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“…Fatal consequences such as acute gastric dilatation and hypophosphataemia can occur quickly. 9 Hypophosphataemia can develop with a high carbohydrate load; if severe, it can cause cardiac and respiratory failure, delirium and fits.…”

Section: Stabilisation Of At-risk Casesmentioning

confidence: 99%

Nutrition and mental health

Treasure

Williams

2004

Clinical Medicine

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“…Patients at risk should receive micronutrient supplements, particularly thiamine, from the outset of feeding; many patients also require aggressive potassium, phosphate and magnesium supplementation since plasma concentrations of these predominantly intracellular cations can plummet during early refeeding. 7 At-risk patients also need close observation for cardiac dysrhythmias and fluid overload/pulmonary oedema.…”

Section: Tube Feedingmentioning

confidence: 99%