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Lancet Respir Med. 2015 Dec;3(12):904-5. Nutritional support and refeeding syndrome in critical illness. van Zanten AR. Medical Manager Care Division, Internist-Intensivist, Gelderse Vallei Hospital, Department of Intensive Care Medicine, 6716 RP Ede, Netherlands. Refeeding syndrome refers to the biochemical and clinical symptoms and metabolic abnormalities in malnourished patients undergoing refeeding whether induced by oral, enteral, or parenteral feeding. The syndrome is characterised by low serum concentrations of predominately intracellular ions such as phosphate, magnesium, and potassium; however, abnormalities in the metabolism of glucose, including thiamine defi ciency and levels of sodium and water balance, have been frequently noted (figure). Refeeding syndrome is associated with high morbidity and mortality. The incidence of refeeding syndrome is unknown, which is probably because there is no universally accepted defi nition. However, in patients with anorexia nervosa in a hospital's intensive care unit (ICU), refeeding syndrome has been reported in 10% of patients. Anyone with negligible food intake for more than 5 days or with poor nutritional status is at risk of developing diffi culties associated with refeeding; therefore, many ICU patients are at risk of developing refeeding syndrome. Recommendations that feeding should be started at a maximum 50% of energy demands are based solely on expert opinion. Conversely, some ICU physicians believe that it is safe to prescribe full feeding while aggressively correcting electrolyte concentrations. PMID: 26597130 PII: S2213-2600(15)00433-6 DOI: 10.1016/S2213-2600(15)00433-6 |
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