Elsevier

Nutrition

Volume 24, Issue 6, June 2008, Pages 604-606
Nutrition

International ward rounds
Refeeding syndrome: A potentially fatal condition but remains underdiagnosed and undertreated

https://doi.org/10.1016/j.nut.2008.01.053Get rights and content

Abstract

Objective

To describe two cases of successfully prevented refeeding syndrome in a high-risk group of patients.

Methods

Case 1 was a 70-y-old woman who presented with a 4-mo history of poor dietary intake and ill health due to a connective tissue disease leading to myositis and dysphagia and complicated by respiratory failure needing mechanical ventilation. Twelve hours after starting nasogastric tube feeding, she developed a cardiac arrest from which she was successfully resuscitated. Repeated attempts to wean her from the ventilator failed. Case 2 was a 15-y-old girl who was readmitted after a total colectomy for severe ulcerative colitis with diarrhea and vomiting leading to significant weight loss. Her body mass index was 11.4 kg/m2.

Results

In case 1, after consultation by the clinical nutrition team, the diagnosis of refeeding syndrome was made and the patient was duly started on a high-protein, high-fat, low-carbohydrate diet, multivitamin and trace-element supplements, and electrolyte infusion. Subsequently she was successfully weaned from the ventilator. In case 2, further investigation by the clinical nutrition team revealed low baseline electrolyte concentrations including potassium, magnesium, calcium, and phosphate and low serum albumin. Her low body mass index and baseline electrolyte concentrations put her at high risk of developing refeeding syndrome. She was initially started on low-calorie feeding, multivitamin and minerals, and her electrolytes were carefully monitored. She made a good recovery.

Conclusion

Refeeding syndrome is a life-threatening, underdiagnosed, treatable condition but there is a need for a wider awareness of the condition among health professionals.

Introduction

Refeeding syndrome is a well-recognized but underdiagnosed and potentially fatal condition that occurs in patients with starvation due to any cause, including anorexia nervosa, diarrhea and vomiting, alcoholism, and after operations [1], [2]. The syndrome can occur with parenteral and enteral feedings and almost always develops during the early stages of refeeding. I describe two cases of refeeding syndrome that highlight the need for a wider awareness of this condition.

Section snippets

Case 1

A 70-y-old woman presented with a 4-mo history of ill health, shortness of breath, lethargy, and difficulty in swallowing. Four days before admission she became drowsy and more breathless. She also complained of dry eyes and mouth. She was known to be hypertensive on nifedipine and was taking steroids until 2 mo before admission for a connective tissue disorder. She also had lost weight but did not know exactly how much.

On clinical examination she was disorientated with a pulse of 120

Discussion

Refeeding syndrome is a well-recognized but underdiagnosed and potentially fatal condition that occurs in patients with starvation due to any cause, including anorexia nervosa, diarrhea and vomiting, alcoholism, and after operations [1], [2]. Malnourished elderly patients and patients with neurologic dysphagia who are being fed through nasogastric and percutaneous endoscopic gastrostomy tubes may also be at risk. [3].

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