Refeeding syndrome inadequate awareness and confidence knowledge of the refeeding syndrome poor among paediatric middlegrade doctors. Refeeding syndrome is a lifethreatening condition that often goes unrecognized. Refeeding syndrome is a well described but often forgotten condition. Refeeding syndrome can be fatal if not recognized and treated properly. Jun 28, 2008 refeeding syndrome is a well described but often forgotten condition. The primary aim of refeeding is to alleviate the short and long term physical and psychological sequelae of malnutrition. Lessons learned with rs, primarily magnesium and potassium. Both patients were severely malnourished and developed the complication within days of starting the feeds. Refeeding syndrome following exclusive enteral nutritional t. The guidelines for refeeding syndrome have been developed by the western cape paediatric nutrition working group in response to the need for evidencebased guidelines with respect to the nutrition management of this condition. Refeeding syndrome is a potentially fatal consequence of reintroduction of adequate nutrition in a malnourished patient. This syndrome is of particular import ance to critically ill patients, who can be moved from the starved state to the fed state rapidly via enteral or parenteral nutrition.
Mar 28, 20 determine the incidence of refeeding syndrome, defined by the presence of hypophosphatemia in verylowbirthweight vlbw infants with intrauterine growth restriction iugr compared with those. Upon refeeding insulin secretion stimulates intracellular glucose and electrolyte uptake leading to. Incidence of refeeding syndrome is rare in children with. Jan 06, 2020 refeeding is the process of reintroducing food after malnourishment or starvation. Its a serious and potentially fatal condition that involves sudden shifts in your bodys fluid and electrolyte balance.
The insulin release drives glucose into cells for quick utilization which simultaneously drives cellular update of. Evaluate the patient at risk for refeeding syndrome. However, restoring weight by refeeding patients can rarely lead to the refeeding syndrome, which is potentially fatal. Magnesium is required for more than 300 enzyme pathways. Refeeding syndrome guideline royal childrens hospital. Evidencebased information on refeeding guidelines paediatrics from hundreds of trustworthy sources for health and social care. For more information on subscription options, click below on the option that best describes you. Refeeding syndrome rfs encompasses the clinical complications that occur as a result of fluid and electrolyte shifts during nutrition repletion of malnourished patients. The pathophysiology of refeeding syndrome is attributed to the bodys instantaneous conversion from a catabolic state to an anabolic state.
The following includes a proposed unifying clinical definition of rs as well as proposed updated criteria for rs risk. The pathophysiology of the refeeding syndrome has been established. Refeeding syndrome guideline the royal childrens hospital. However, the incidence and risk factors of refeeding syndrome like electrolyte disturbance in premature infants remain unclear. Why is it important to monitor for refeeding syndrome in a severely malnourished patient who is started on pn. Aspen consensus recommendations for refeeding syndrome. Nov 11, 2019 pediatric annals refeeding syndrome describes the metabolic disturbances and clinical sequelae that occur in response to nutritional rehabilitation of patients who are moderate to severely. Refeeding guideline refeeding is indicated only when there is evidence of nutritional deficiency, e. Refeeding syndrome a practical approach peng prebapen conference teaching day birmingham. Guidelines for prevention and management of refeeding.
Risk factors for the development of refeeding syndromelike. Treatment of hypophosphatemia is usually not necessary unless the plasma. Nutritional refeeding syndrome kwashiorkar and marasmus. Com plications of the refeeding syndrome can include electro lyte abnormalities, heart failure, respiratory failure, and death 1,2,3,4. Acuteonset vomiting, fever, and bulging fontanelle in a 7monthold boy clarissa fernandezpol, matthew ben wallenstein, ian chua. A 16 yearold girl with anorexia nervosa fails outpatient treatment.
Jun 14, 2016 sydney childrens hospital guidelines and cape town pediatric interest group suggest 2 mgkg of thiamine daily during the first week of sam treatment to prevent refeeding syndrome and its consequences 118, 119. Management and prevention of refeeding syndrome in. This article explains the causes, symptoms and risk factors of refeeding syndrome, as well as information on how its typically treated. Historical aspects some of the adverse consequences of refeeding were welldescribed in the medical literature in the page 1027. Dec 03, 2018 refeeding syndrome is an adverse response by your body that occurs with refeeding. A 16yearold girl with anorexia nervosa fails outpatient treatment. Nutritional support in malnourished paediatric patients. Risk assessment, diagnostics and management chapter pdf available june 2014 with 1,689 reads how we measure reads.
The shifts in fluids and electrolytes can lead to complications during artificial feeding and if not recognized and untreated can lead to death. The aap is launching a new, weekly podcast that will explore breaking news and developments in pediatric health, the science behind child health recommendations, research and other timely topics. Hypomagnesemia is defined as serum mg pdf available in nutrition in clinical practice 356 march 2020 with 373 reads how we measure reads. Refeeding syndrome describes the metabolic disturbances and clinical sequelae that occur in response to. Refeeding syndrome is found in those who undergo reinstitution of enteral or parenteral feeds after a prolonged period of malnutrition or anorexia. Uncomplicated pediatric patients with failure to thrive have a low risk of refeeding syndrome. Where possible, patients at extremely high risk should have continuous cardiac monitoring, as should any patient who develops cardiac. An awareness of the condition and a high index of suspicion are required in order to make the diagnosis. 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. Analyze patient scenarios for refeeding syndrome risk factors.
This bestselling resource aids in the diagnosis and treatment of more than 100 of the most commonly seen pediatric infectious diseases. In this article, we report 2 further patients with cd who developed refeeding syndrome on receiving exclusive enteral nutrition. Jan 12, 2014 nutritional refeeding syndrome kwashiorkar and marasmus indore pedicon 2014 1. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition.
Risk groups and pathogenesis the refeeding syndrome is seen in. Nutritional recovery refeeding syndromekwashiorkar and marasmus dr rajesh kulkarni pune 2. The importance of the refeeding syndrome johns hopkins medicine. Refeeding syndrome is a welldescribed state of the series of metabolic and biochemical changes that occur during the supplemental feeding of malnourished patients. The electrolyte disturbances of the refeeding syndrome can occur within the first few days of refeeding. Refeeding syndrome was first described in the 1940s. The biochemical hall mark of refeeding syndrome is hypophosphataemia6.
Refeeding syndrome is a welldescribed state of the series of metabolic and biochemical changes that occur during the supplemental feeding. Refeeding syndrome in children in developing countries who h. Aspen consensus recommendations for refeeding syndrome da. Rio et al 20 and mehler et al 2010 have proposed the following strategies to avoid the refeeding syndrome. Refeeding syndrome in verylowbirthweight intrauterine. One of the primary reasons for this lack of agreement is the inherent difficulty in studying patients with refeeding syndrome. How is refeeding syndrome prevented in the treatment of. Cnsg east cheshire nhs trust guidelines for prevention and management of refeeding syndrome in adults page 9 of 11 5. Clinical guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate nutrition care for specific clinical circumstances. Refeeding syndrome rfs is the result of aggressive enteral or parenteral feeding in a malnourished patient, with hypophosphatemia being the hallmark of this. Thiamine therapy and refeeding syndrome in extremely low. Refeeding syndrome is a state of fluid and electrolyte imbalances that can lead.
The rapid influx of nutrients can lead to fluctuations in electrolytes and fluid. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment. Refeeding syndrome precipitate when fatal shifts in fluids and electrolytes occur. No randomised controlled trials of treatment have been published, although there are.
Refeeding syndrome has often been reported in anorexic, postoperative, and chronic alcoholic adults and in the pediatric population 7, 8. Refeeding syndrome this paper describes rs, conceptually, as a measurable reduction in levels of 1 or any combination of phosphorus, potassium, andor magnesium, or the manifestation of thiamin deficiency, developing shortly hours to days after initiation of calorie provision to an individual who has been exposed to a substantial period of undernourishment. Case scenario ram a 18 month old boy was brought to hospital with co poor weight gain. Pediatric annals refeeding syndrome describes the metabolic disturbances and clinical sequelae that occur in response to nutritional. Institute of medicine clinical guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. Pulcini, stacey zettle, arvind srinath 524 parathyoid r disorders morri e. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. Hudson et al 20% unable to define it at all 21% able to identify some clinical features 57% aware of potential phosphate abnormalities higher levels of confidence in gastroenterologists vs general. Shaker rouba, charafeddine fatme, charafeddine lama department of pediatrics and adolescent medicine, american university of beirut medical center, beirut, lebanon. Whether traveling or not, trainees wanting to supplement their routine pediatric education with global health perspectives can use the learning objectives and resources at the global health pediatric education group peg of the association of pediatric program directors to grow in an ability to adapt good pediatric knowledge to parts of the. What is refeeding syndrome refeeding syndrome is the cascade of potentially fatal complications caused by shifts in fluid and electrolytes as nutrition is reintroduced into the body, taxing wasted and weakened tissues and demanding more nutrients than are readily available.
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