Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

Pantoja, Felipe; Fragkos, Konstantinos C.; Patel, Pinal; Keane, Niamh; Samaan, Mark A; Barnova, I; Di, Simona; Mehta, Shameer; Rahman, Farooq

doi:10.1016/j.clnu.2018.06.967

Cited by 16 publications

(14 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the hospital setting, where close attention to electrolyte levels is standard of care, complications of refeeding may, in fact, be rare 64,65 . Until a unifying definition for RS is used in studies, the incidence will be poorly understood and identifying characteristics of patients at risk very challenging.…”

Section: Populations Potentially At Risk For Refeeding Syndromementioning

confidence: 99%

“…In the hospital setting, where close attention to electrolyte levels is standard of care, complications of refeeding may, in fact, be rare. 64,65 Until a unifying definition for RS is used in studies, the incidence will be poorly understood and identifying characteristics of patients at risk very challenging. However, the consistent characteristic of risk that emerge from clinical experience and scientific observation include prolonged undernourishment, particularly in the face of ongoing electrolyte loss.…”

Section: Populations Potentially At Risk For Refeeding Syndromementioning

confidence: 99%

See 1 more Smart Citation

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

View full text Add to dashboard Cite

Introduction In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. Methods Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. Findings/Recommendations This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%–20% (mild), 20%–30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. Conclusions These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

show abstract

Section: Populations Potentially At Risk For Refeeding Syndromementioning

confidence: 99%

Section: Populations Potentially At Risk For Refeeding Syndromementioning

confidence: 99%

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

View full text Add to dashboard Cite

show abstract

“…massive transfusions) or redistribution of Mg into bone and soft tissue (during alkali therapy and total parenteral nutrition). 146 , 147 …”

Section: Drugs Associated With Hypomagnesemiamentioning

confidence: 99%

An overview of diagnosis and management of drug‐induced hypomagnesemia

Liamis

Hoorn

Florentin

et al. 2021

Pharmacology Res & Perspec

View full text Add to dashboard Cite

Hypomagnesemia is usually defined as a serum magnesium (Mg) level below 0.65 mmol/L (1.3 mEq/L; 1.5 mg/dl). 1 Serum Mg exists in three forms: (1) free or ionized Mg, the physiologically active form that accounts for 55%-70% of total serum Mg; (2) Mg complexed to anions, including bicarbonates, sulfates, phosphates, and citrates (5%-15%) and (3) Mg bound to serum proteins (primarily albumin), constituting the remaining approximately 30%. 2 Similarly to hypocalcemia, hypoalbuminemia is also related to spurious hypomagnesemia. 3 Consequently, in hypoalbuminemic states (serum albumin <4 g/dl) corrected serum Mg should be calculated using the formula: corrected Mg (mmol/L) = measured Mg(mmol/L) + 0.005 × (40 − albumin g/L). 4 Correction of Mg for albumin levels is rarely performed in clinical practice, a strategy that should probably change.The incidence of hypomagnesemia varies considerably from merely 2% among individuals in the community up to as high as 65% in patients hospitalized in intensive care units. 5,6 Discrepancies in the reported incidences of hypomagnesemia are attributed to the fact that serum Mg is not routinely measured and that this ion is

show abstract

“…Parenteral nutrition is indicated when oral and/or enteral nutrition are insufficient or in the case of failure of the gut function. The risk of RFS may be greater with enteral or parenteral feeding compared to oral intake, thus artificial nutrition should be started cautiously at a reduced caloric rate [4,28,29,52,[63][64][65][66].…”

Section: Macronutrientsmentioning

confidence: 99%

Management of Refeeding Syndrome in Medical Inpatients

Reber

Friedli

Vasiloglou

et al. 2019

JCM

View full text Add to dashboard Cite

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.

show abstract

Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

Cited by 16 publications

References 26 publications

ASPEN Consensus Recommendations for Refeeding Syndrome

ASPEN Consensus Recommendations for Refeeding Syndrome

An overview of diagnosis and management of drug‐induced hypomagnesemia

Management of Refeeding Syndrome in Medical Inpatients

Contact Info

Product

Resources

About