Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Renourishment is the process of avoiding refeeding syndrome. The syndrome was first described in Japanese war prisoners after the Second World War.

Syndrome

Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. Most effects result from a sudden shift from fat to carbohydrate metabolism and a sudden increase in insulin levels after refeeding which leads to increased cellular uptake of phosphate. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes including phosphate, potassium, magnesium, glucose, and thiamine. Significant risks arising from refeeding syndrome include confusion, coma, convulsions, and death.

This syndrome can occur at the beginning of treatment for anorexia nervosa when patients are reintroduced to a healthy diet. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is also increased which strains the respiratory system and can make weaning from ventilation more difficult.

Treatment

Refeeding syndrome can be fatal if not recognized and treated properly. If potassium,phosphate or magnesium are low then this should be corrected. Prescribing thiamine, B Costrong and a multivitamin and mineral is recommended. Biochemistry should be monitored regularly until it is stable.

References

Shils, M.E., Shike, M., Ross, A.C., Caballero, B. & Cousins, R.J. (2006). Modern nutrition in health and disease, 10th ed. Lippincott, Williams & Wilkins. Baltimore, MD. Mahan, L.K. & Escott-Stump, S.E. (2004) Krause’s Food, Nutrition, & Diet Therapy, 11th ed. Saunders, Philadelphia, PA.

• Hearing S (2004). "Refeeding syndrome.". BMJ 328 (7445): 908–9.
• Crook M, Hally V, Panteli J "The importance of the refeeding syndrome.". Nutrition 17 (7-8): 632–7.
• Lauts N "Management of the patient with refeeding syndrome.". J Infus Nurs 28 (5): 337–42.
• Kraft M, Btaiche I, Sacks G (2005). "Review of the refeeding syndrome.". Nutr Clin Pract 20 (6): 625–33.