Risk factors of refeeding syndrome in malnourished older hospitalized patients

Pourhassan, Maryam; Cuvelier, I.; Gehrke, I.; Marburger, Christian; Modreker, Mirja Katrin; Volkert, Dorothee; Willschrei, H.P.; Wirth, Rainer

doi:10.1016/j.clnu.2017.06.008

Cited by 36 publications

(42 citation statements)

References 23 publications

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“…Known risk factors for the RFS are a reduced BMI, significant unintended weight loss, no nutritional intake for several days, low plasma concentrations of magnesium, potassium or phosphate before feeding and a medical history of drug or alcohol abuse [196], and it has recently been observed that these risk factors are very common in older hospitalized patients [197]. A large overlap between the risk of malnutrition according to common screening tools and the risk of RFS was observed in the same patient group [198], suggesting that in older persons with malnutrition or at risk of malnutrition a risk of RFS should generally be taken into consideration.…”

Section: Recommendation 39 Recommendation 40mentioning

confidence: 99%

ESPEN guideline on clinical nutrition and hydration in geriatrics

et al. 2019

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Section: Recommendation 39 Recommendation 40mentioning

confidence: 99%

ESPEN guideline on clinical nutrition and hydration in geriatrics

et al. 2019

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“…Starvation remains the most reliable predictor of RFS [28]. Nutritional risk screening 2002 ≥ 3 points, polymorbidity, older age, and low serum magnesium (<0.7 mmol/L) were found to be risk factors for RFS in many studies [19,20,28,[32][33][34][35][36][37][38]. According to the literature and to our long-lasting daily clinical experience, there are many clinical conditions at particular risk of developing RFS (see Table 1).…”

Section: Individual Risk Assessmentmentioning

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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“…The risk of developing RFS is suggested to be particularly high in geriatric patients. Pourhassan et al indicated a high prevalence of risk factors of the RFS (70%) in 342 older individuals acutely admitted in geriatric hospital units according to the NICE Guideline criteria [8,9]. Thus the real prevalence of the RFS is unknown [6].…”

Section: Introductionmentioning

confidence: 99%