The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

Abstract

The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2–5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.

Refeeding Syndrome after Gastrectomy in a Patient with Hypophosphatemia: A Case Report

“…RFS is manifested by an imbalance of electrolytes (particularly phosphate, potassium, and magnesium), vitamin depletion (e.g., vitamin B1 thiamine deficiency), fluid imbalances, and organ dysfunctions, which are associated with mortality and other adverse clinical outcomes [2,3,10]. Hypophosphatemia is the most common symptom of RFS and can lead to several clinical manifestations, such as rhabdomyolysis, hemolysis, respiratory failure, and musculoskeletal disorders [2,10].…”

“…Inadvertent nutritional treatment can cause a potentially fatal clinical condition, such as refeeding syndrome (RFS), in malnourished or metabolically stressed patients [2]. RFS is an exaggerated metabolic response to resumption of nutrition in malnourished patients and is characterized by electrolyte disturbances, vitamin deficiencies, and fluid overload, which can lead to many organ dysfunctions [2,3]. Despite long-standing recognition as a serious clinical complication with a high mortality rate, RFS has been frequently overlooked, underdiagnosed and often inappropriately treated even if recognized [2,4].…”

“…Despite long-standing recognition as a serious clinical complication with a high mortality rate, RFS has been frequently overlooked, underdiagnosed and often inappropriately treated even if recognized [2,4]. Accurate and early identification of surgical patients who are at risk for RFS may allow optimization of preoperative nutrition and prevention of RFS [3].…”

Nutritional Support in Malnourished Children With Compromised Gastrointestinal Function: Utility of Peptide-Based Enteral Therapy

“…Although the exact pathophysiological mechanisms remain unknown, the switch from a catabolic to an anabolic state via rapid refeeding in a starved patient is considered likely to cause of the clinical manifestations of the refeeding syndrome (RFS) ( 79 , 80 ). While the carbohydrates play the key role in RFS via stimulation of insulin secretion and thus emergence of a sudden shift from fat to carbohydrates metabolism, proteins may also affect the insulin secretion ( 79 , 80 ). Nonetheless, while the isocaloric properties of peptide-based formulas seems to offer a steady increase in calorie intake, currently there is no evidence regarding the potential advantages or disadvantages of using peptide-based formula in the RFS.…”

The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome

“…Refeeding syndrome (RFS) refers to the biochemical and clinical symptoms, and metabolic abnormalities in malnourished patients undergoing refeeding, whether induced via oral, enteral, or parenteral feeding, and the hallmark of this phenomenon is hypophosphatemia [ 1 , 2 , 3 ]. RFS may lead to coma, lethal cardiac arrhythmias, heart arrest, acute respiratory failure, and even death [ 4 , 5 ]. Previous studies have connected a longer Intensive Care Unit (ICU)stay, increased mortality, and disability with the occurrence of RFS [ 6 , 7 , 8 ].…”