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.

  • Letter to the Editor
  • Published:

Hyperinsulinemia has prominent role in refeeding syndrome pathophysiology

Journal of Perinatology volume 34, pages 247–248 (2014)Cite this article

Subjects

We appreciate the comments by Hakan et al.1 regarding the potential pathogenesis of the severe hypophosphatemia and additional electrolyte dyscrasias in the intrauterine growth-restriction (IUGR) population. We agree that the most likely mechanism for the reported electrolyte abnormalities is a transient hyperinsulinemia. Increased release of insulin in response to the carbohydrate load with refeeding a chronically malnourished patient has been implicated as the key trigger for many of the electrolyte disturbances seen with refeeding syndrome.2, 3

In the IUGR neonatal population, we hypothesize that the pathophysiology of hypophosphatemia, hypokalemia and hypomagnesemia is similar to that of other patients at risk for refeeding syndrome with hyperinsulinemia having a key role. In addition, the initial risk for severe hypoglycemia due to decreased glycogen stores poses a significant challenge to this group. Early hypoglycemia with subsequent requirement for increased glucose delivery in many of these neonates results in further stimulation for insulin secretion resulting in worsening hypophosphatemia, hypokalemia and hypomagnesemia.

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. Hakan N, Aydin M, Dilli D, Zencrioglu A, Okumus N . Transient hyperinsulinemia may be responsible from electrolyte abnormalities of refeeding syndrome seen in very-low-birth-weight infants with intrauterine growth-restriction. J Perinatol 2014 (this issue).

  2. Boateng AA, Sriram K, Meguid MM, Crook M . Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition 2010; 26 (2): 156–167.

    Article  Google Scholar 

  3. Kohn MR, Madden S, Clarke SD . Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr 2011; 23 (4): 390–394.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    J R Ross & S N Taylor

Authors
  1. J R Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S N Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J R Ross.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ross, J., Taylor, S. Hyperinsulinemia has prominent role in refeeding syndrome pathophysiology. J Perinatol 34, 247–248 (2014). https://doi.org/10.1038/jp.2013.188

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2013.188

Search

Advanced search

Quick links