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Clinical nutrition

Further evidence to throw caution to the wind: outcomes using an assertive approach to manage refeeding syndrome risk

European Journal of Clinical Nutrition volume 75, pages 91–98 (2021)Cite this article

Subjects

Abstract

Background/objectives

Refeeding syndrome (RFS) can occur in severely malnourished or starved populations that are provided with rapid or unbalanced nutrition. International guidelines recommend a cautious approach for managing RFS risk (hypocaloric nutrition for 4–7 days), however emerging evidence supports a more assertive approach. This study aimed to describe nutritional management and RFS-related adverse outcomes in patients at risk of RFS receiving care after implementing updated guidelines reflecting emerging evidence.

Subjects/methods

A retrospective cohort study of inpatients at risk of RFS during admission to a large metropolitan hospital in Queensland, Australia between November 2018 and April 2019 was conducted. Data were collected from medical records on nutritional management (provision of nutrition, electrolyte, and vitamin replacement) and outcomes (incidence of RFS, serum electrolyte decreases, hypo/hyperglycaemia, oedema, and organ function disturbance). Data were analysed descriptively; relationships between serum electrolyte decreases and nutrition management were explored using Fisher’s Exact tests.

Results

Of the 70 patients identified at risk of RFS (58.4 ± 16.8 years, 56% male, 94% malnourished), majority of participants received required supplementation prior to the commencement of nutrition (thiamine: 76%; micronutrients: 72–100%; multivitamin: 61%) and a standard initial nutrition management plan (79%; cautious: 13%; liberal: 8%). There were no cases of RFS. Four participants experienced RFS-related adverse outcomes (severe electrolyte decreases: n = 2, hypo/hyperglycaemia: n = 2); however, there was no differences in serum electrolyte decreases based on the nutrition management plan (initial: p = 0.912; goal: p = 0.688).

Conclusions

The implementation of more liberal RFS guidelines for the management of RFS risk appears to be safe. Further research examining liberalised refeeding protocols may be useful in updating international guidelines.

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Fig. 1: Flowchart of eligible and ineligible participants.

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Acknowledgements

We would like to acknowledge the Royal Brisbane and Women’s Hospital Allied Health Research and Nutrition and Dietetics Department for their support in data collection and providing all required resources throughout the research process. This research was also supported by Dr. Peter Collins from the University of Queensland Human Movement and Nutrition Sciences School.

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Authors and Affiliations

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

    Candice Drysdale & Kylie Matthews-Rensch

  2. Nutrition and Dietetics Department, The Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

    Kylie Matthews-Rensch & Adrienne Young

Authors
  1. Candice Drysdale
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  2. Kylie Matthews-Rensch
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  3. Adrienne Young
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Contributions

KMR and AY contributed to the conception of the project. KMR and CD contributed to the design of the research project. CD contributed to the acquisition of data. KMR, CD, and AY analysed and interpreted data. CD drafted the paper. KMR, AY, and CD revised the final paper. KMR and AY provided guidance throughout the project.

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Correspondence to Candice Drysdale.

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The authors declare that they have no conflict of interest.

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Drysdale, C., Matthews-Rensch, K. & Young, A. Further evidence to throw caution to the wind: outcomes using an assertive approach to manage refeeding syndrome risk. Eur J Clin Nutr 75, 91–98 (2021). https://doi.org/10.1038/s41430-020-0676-6

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