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Refeeding syndrome

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Illness caused by the sudden feeding of a malnourished individual

{{cite web | title=Evidence — Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition — Guidance | publisher=[[National Institute for Health and Care Excellence]] (NICE) |orig-date=Updated 4 August 2017|date=22 February 2006 | url=https://www.nice.org.uk/guidance/cg32/evidence}} Web page with link to full guideline CG32.{{rp|37–38}}}}"},"diagnosis":{"wt":""},"differential":{"wt":""},"prevention":{"wt":""},"treatment":{"wt":""},"medication":{"wt":""},"prognosis":{"wt":""},"frequency":{"wt":""},"deaths":{"wt":""}},"i":0}}]}'>Medical condition<br>Refeeding syndromeA malnourished Afghan child being treated by a medical teamSpecialtyGastroenterologyComplicationselectrolyte imbalance, heart failure, cardiac arrhythmia, respiratory failure, seizure, comaRisk factorsStarvation<br>Dehydration<br>Malnutrition<br>Very low weight<br>Unintentional weight loss<br>Low levels of potassium, phosphate, or magnesium before eating<br>Alcoholism<br>Prolonged fasting<br>Torture<br>Metabolic syndrome<br>Anorexia nervosa<br>Avoidant/restrictive food intake disorder<br>Some types of medications[1]: 37–38

Refeeding syndrome (RFS ) is a metabolic disturbance which occurs as a result of reinstitution of nutrition in people who are starved, severely malnourished, or metabolically stressed because of severe illness. When too much food or liquid nutrition supplement is consumed during the initial four to seven days following a malnutrition event, the production of glycogen, fat and protein in cells may cause low serum concentrations of potassium, magnesium and phosphate.[2][3] The electrolyte imbalance may cause neurologic, pulmonary, cardiac, neuromuscular, and hematologic symptoms—many of which, if severe enough, may result in death.

Cause<br>[edit]

Any individual who has had a negligible nutrient intake for many consecutive days and/or is metabolically stressed from a critical illness or major surgery is at risk of refeeding syndrome. Refeeding syndrome usually occurs within four days of starting to re-feed. Patients can develop fluid and electrolyte imbalance, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.[citation needed]

During fasting, the body switches its main fuel source from carbohydrates to initially fatty acids from fat tissue during ketosis and later amino acids from protein sources such as muscle as its main energy sources. The body begins to selectively consume muscle as a protein source via autophagy after prolonged fasting, and starvation ensues when all fat reserves have been depleted and protein becomes the only fuel source. However, it is possible for death to occur before the fat reserves have been entirely depleted due to the weakening of the internal organs from the autophagy. The spleen also decreases its rate of red blood cell breakdown, thus conserving red blood cells. Many intracellular minerals become severely depleted during this period, although serum levels remain normal. Importantly, insulin secretion is suppressed in this fasting state, and glucagon secretion is increased.[2]

During refeeding, insulin secretion resumes in response to increased blood sugar, resulting in increased glycogen, fat, and protein synthesis. Therefore, the basal metabolic rate increases. This process requires phosphates, magnesium and potassium which are already depleted, with any remaining available rapidly used up. Formation of phosphorylated carbohydrate compounds in the liver and skeletal muscle depletes intracellular ATP and 2,3-diphosphoglycerate in red blood cells, leading to cellular dysfunction and inadequate oxygen delivery to the body's organs. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes, including phosphate and magnesium. Levels of serum glucose may rise, and B1 vitamin (thiamine) may fall. Abnormal heart rhythms are the most common cause of death from refeeding syndrome, with other significant risks including confusion, coma, convulsions, and cardiac failure.[citation needed]

Anorectics<br>[edit]

An anorectic is a drug which reduces appetite, resulting in lower food consumption, leading to weight loss.[4]

Examples of anorectics includes stimulants like amphetamines, methylphenidate, and cocaine, along with opiates. Abusing them can lead to prolonged periods of inadequate calorie intake. If someone misuses these substances and then starts eating normally again, they may be at increased risk of refeeding syndrome.[4]

Clinical situations<br>[edit]

The...