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Clinical nutrition

Throw caution to the wind: is refeeding syndrome really a cause of death in acute care?

European Journal of Clinical Nutrition volume 72, pages 93–98 (2018)Cite this article

Subjects

Abstract

Background/Objectives:

Refeeding syndrome (RFS), a life-threatening medical condition, is commonly associated with acute or chronic starvation. While the prevalence of patients at risk of RFS in hospital reportedly ranges from 0 to 80%, the prevalence and types of patients who die as a result of RFS is unknown. We aimed to measure the prevalence rate and examine the case histories of patients who passed away with RFS listed as a cause of death.

Subjects/Methods:

Patients were eligible for inclusion provided their death occurred within a Queensland hospital. Medical charts were reviewed, for medical, clinical and nutrition histories with results presented using descriptive statistics.

Results:

Across 18 years (1997–2015) and ~260000 hospital deaths, five individuals (4F, 74 (37–87)yrs) were identified. No patient had a past or present diagnosis, such as anorexia nervosa, that would classify them as at high risk for RFS. RFS was not listed as the primary cause of death for any patient. No individual consumed >3400 kJ per day. Limited consensus was observed in the signs and symptoms used to diagnose RFS, although all patients experienced low levels of potassium, phosphate and/or magnesium. Eighty percent of electrolytes improved before death.

Conclusions:

RFS was a rare underlying cause of death, despite reported high prevalence rates of risk. Patient groups usually considered to be at high risk were not identified, suggesting a level of imprecision with the interpretation of criteria used to identify RFS risk. More detailed research is warranted to assist in the identification of those distinctly at risk of RFS.

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Acknowledgements

We would like to acknowledge the support from the four Queensland hospitals that provided access to patient chart/s. This work was supported by the Research Committee at Logan Hospital, Meadowbrook, Australia.

Author contributions

MAP contributed to the conception and design of the research project. KLM contributed to the design of the research project and the acquisition, analysis and interpretation of the data. KLM drafted the manuscript. KLM, SMC and MAP critically revised the manuscript and approved the final manuscript. SMC and MAP provided expert guidance throughout the entire project.

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Authors and Affiliations

  1. School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia

    K L Matthews & S M Capra

  2. Nutrition and Dietetics, Logan Hospital, Meadowbrook, Queensland, Australia

    M A Palmer

Authors
  1. K L Matthews
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Correspondence to K L Matthews.

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Matthews, K., Capra, S. & Palmer, M. Throw caution to the wind: is refeeding syndrome really a cause of death in acute care?. Eur J Clin Nutr 72, 93–98 (2018). https://doi.org/10.1038/ejcn.2017.124

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