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Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment

Abstract

The refeeding syndrome is a potentially lethal complication of refeeding in patients who are severely malnourished from whatever cause. Too rapid refeeding, particularly with carbohydrate may precipitate a number of metabolic and pathophysiological complications, which may adversely affect the cardiac, respiratory, haematological, hepatic and neuromuscular systems leading to clinical complications and even death. We aimed to review the development of the refeeding syndrome in a variety of situations and, from this and the literature, devise guidelines to prevent and treat the condition. We report seven cases illustrating different aspects of the refeeding syndrome and the measures used to treat it. The specific complications encountered, their physiological mechanisms, identification of patients at risk, and prevention and treatment are discussed. Each case developed one or more of the features of the refeeding syndrome including deficiencies and low plasma levels of potassium, phosphate, magnesium and thiamine combined with salt and water retention. These responded to specific interventions. In most cases, these abnormalities could have been anticipated and prevented. The main features of the refeeding syndrome are described with a protocol to anticipate, prevent and treat the condition in adults.

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Acknowledgements

AB has been supported by grants from the Swiss Foundation for Nutrition Research and the Swiss Society for Internal Medicine.

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Correspondence to D N Lobo.

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Contributors: ZS: study design, data collection, data interpretation and analysis, preparation of paper and critical review. AB: data collection, data interpretation and analysis, preparation of paper and critical review. ML: data collection and preparation of paper. RFG and AS: data interpretation, preparation of paper and critical review. SPA and DNL: study design, data interpretation and analysis, preparation of paper and critical review.

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Stanga, Z., Brunner, A., Leuenberger, M. et al. Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr 62, 687–694 (2008). https://doi.org/10.1038/sj.ejcn.1602854

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  • DOI: https://doi.org/10.1038/sj.ejcn.1602854

Keywords

  • refeeding syndrome
  • hypophosphataemia
  • hypomagnesaemia
  • thiamine deficiency
  • nutritional therapy
  • guidelines

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