Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Response to Letter to the Editor
  • Published:

Response to Letter

Refeeding encephalopathy revisited: Reply to Tasci et al.

European Journal of Clinical Nutrition volume 69, page 976 (2015)Cite this article

Subjects

We thank Dr Tasci et al.1 for their interest in our case report 'Refeeding encephalopathy in a patient with severe hypophosphataemia and hyperammonaemia'2 and for drawing our attention to the importance of including acid–base status in the evaluation of the comatose malnourished patient. In their letter, Dr Tasci et al. point to a number of relevant issues.

Comorbidity, in particular inflammation or cancer, and reduced food intake add to the risk of developing the refeeding syndrome. This patient had preexisting Crohn’s disease and a non-healing sacral ulcer, which may have impaired the overall nutritional status and contributed to the clinical state on admission. We suspected a high risk of the refeeding syndrome due to chronic undernutrition, indicated by a low body mass index of 16 kg/m2. In addition, the patient had a very little nutritional intake for more than ten days (exact time not mentioned in the case report). This means that she fulfills the criteria for the risk of refeeding syndrome stated by Crook3 and current guidelines.4 Further, the patient had an increased nutritional risk score according to the NRS20025 at the initial surgical admission, which was not mentioned in the case report.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Tasci I, Bulucu MF, Saglam K . Acid–base disturbances may complicate the diagnosis of refeeding syndrome. Eur J Clin Nutr 2015, e-pub ahead of print 11 March 2015 doi:10.1038/ejcn.2015.34.

  2. Becker S, Dam G, Hvas CL . Refeeding encephalopathy in a patient with severe hypophosphataemia and hyperammonaemia. Eur J Clin Nutr 2014; 69: 279–281.

    Article  Google Scholar 

  3. Crook MA . Refeeding syndrome: problems with definitions and management. Nutrition 2014; 30: 1448–1455.

    Article  Google Scholar 

  4. NICE guideline 32: Nutrition support in adults. London: National Institute for Health and Care Excellence, 2006.

  5. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22: 321–336.

    Article  Google Scholar 

  6. Aveda MM, Souto G, Blanco N, Donapetry C . Ammonium metabolism in humans. Metabolism 2012; 61: 1495–1511.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

    C L Hvas, S Becker & G Dam

Authors
  1. C L Hvas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Dam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C L Hvas.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hvas, C., Becker, S. & Dam, G. Refeeding encephalopathy revisited: Reply to Tasci et al.. Eur J Clin Nutr 69, 976 (2015). https://doi.org/10.1038/ejcn.2015.43

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.43

Search

Advanced search

Quick links