Refeeding Syndrome

What is Refeeding Syndrome?

Refeeding Syndrome refers to a group of clinical symptoms that occur in individuals who were severely malnourished and who are currently receiving nutrition.

For various reasons, the bodies of these individuals would have been undergoing chronic malnutrition and now as a part of nutritional rehabilitation, they are receiving more nutrients into their body suddenly.

This form of nutritional rehabilitation or refeeding is risky as it leads to serious complications in the body of the individual. When the body receives a provision of nutrition suddenly after a period of prolonged starvation, it can cause severe electrolyte shifts and fluid fluctuations.

Causes of Refeeding Syndrome

There are many conditions that could give rise to the occurrence of this syndrome. These could be socioeconomic conditions like poverty that cause them or maybe personal choices like fasting. Some of the conditions that make people vulnerable to refeeding are:

  • Deficiency diseases like Kwashiorkor and Marasmus.
  • Chronic malnutrition
  • Anorexia nervosa
  • Chronic alcoholism
  • Prolonged fasting
  • Hunger strikes
  • Recovering cancer patients
  • Homeless individuals
  • Chronic alcoholism, especially in the case of Korsakoff’s syndrome.
  • Recovering patients with dysphagia
  • Chronic users of antacids and diuretics

The people who are at risk for this condition are those who have been malnourished for at least more than 5 days. The risk factors increase under the following conditions:

  • The person has a BMI less than 16kg/m2.
  • They are severely underweight and have received little or no nutrition for more than 5 days.
  • There are low levels of important minerals like potassium, phosphorus and magnesium in their body.
  • They have lost between 5-10% of their body weight over the past couple of months.

The above conditions make a person more vulnerable towards refeeding syndrome but it does not mean that they will experience it. However, it is important for each individual at risk, to be under the supervision of a medical professional in order to avoid the probable consequences of the fatal complications.

The Refeeding Process

In order to understand the effects of Refeeding Syndrome properly, it is crucial to understand how the body metabolizes food and resources to expend energy.

Before Refeeding

When an individual does not receive nutrition for a long period of time, their body is in a catabolic state. As there are no nutrients for the body to break down, the body starts breaking down the stored fats in the body to release energy for sustenance.

During Refeeding

When nutrition is suddenly provided to the body post this period of prolonged starvation, there is a shift from fat metabolism to carbohydrate metabolism. As food and caloric intake has increased, the body now receives carbohydrates to break down and release energy. This is done to repair and rebuild the cells and tissues of the body.

During this rebuilding process, vital minerals like potassium and phosphorus move from the blood into the cells, thereby reducing the concentration of blood. Phosphorus is an important electrolyte of the body. When phosphorus levels decrease in the blood, it causes serious complications like weakness, muscle wear and tear and arrhythmia. Another important electrolyte is potassium. When potassium levels decrease, it can even result in seizures and sudden death. When magnesium levels decrease, it can cause neuromuscular problems and cardiac dysfunction.  In both the cases, the sudden change in electrolyte balance causes the heart tow work faster and this causes the arrhythmia which is common in Refeeding Syndrome.

Symptoms and Effects of Refeeding

How do we know if a previously malnourished individual is showing the symptoms of Refeeding Syndrome? In addition to the above metabolic effects, the syndrome is often accompanied by a host of internal complications such as:

  • Vitamin Deficiency (Thiamine)
  • Altered glucose metabolism
  • Fluid retention
  • Seizures
  • Cardiac Arrests
  • Weakness
  • Breathlessness
  • Dehydration
  • Prerenal failure
  • Delirium
  • Anaemia
  • Muscle breakdown
  • Low blood pressure
  • Respiratory failure
  • Coma
  • Sudden death

Prevention and Treatment of Refeeding Syndrome

  1. The most important measure is to be aware of this phenomenon. Many people especially those who undertake prolonged fasting for various reasons are not aware of the serious nature of the complications.
  2. Identify individuals who are at high risk for refeeding syndrome. Any person who has had very low nutritional food intake for more than five days is at risk here.
  3. When put in nutritional rehabilitation, the blood biochemistry needs to be monitored properly to avoid complications of sudden refeeding. If the patient does not show any symptoms of refeeding, then the nutritional intake can be increased.
  4. The nutritional repletion varies according to the level of malnourishment of the patient and their dietary modifications should be planned individually. It should not exceed more than 50% of the energy requirements in the beginning. It is important to involve a dietitian who is able to assess the patient and prescribe the adequate amount of nutrition and restore the adequate electrolyte balance.
  5. Vitamins will be prescribed and must be taken. Any supplements for mineral and vitamin intake must be followed seriously. Vitamin replacement must be started immediately and must be followed for atleast 10 days.
  6. Electrolyte levels must be carefully monitored through urine analysis and monitoring blood chemistry.
  7. Fluid retention, insulin levels, glucose metabolism and other metabolic activities must be carefully monitored.

Prognosis of Refeeding Syndrome

If the cases are detected at an early stage, there is good prognosis. With proper nutritional management and precautions, the complications can be prevented from developing further. It is only if this goes undetected and is left untreated, that it can be fatal to one’s heath, resulting in death eventually.

Refeeding Syndrome is a condition that often goes unnoticed by many. It occurs when a previously malnourished individual suddenly increases their nutritional intake. This sudden intake can cause many serious complications. With proper monitoring and precautions, this can be avoided and the person can regain proper health smoothly.

References

www.eatingdisorderhope.com/blog/refeeding-syndrome-overview
lifeinthefastlane.com/ccc/refeeding-syndrome/
uptodate.com/contents/search?search=Refeeding%20Syndrome
dietdoctor.com/fasting-and-re-feeding-syndrome
derangedphysiology.com/main/required-reading/endocrinology-metabolism-and-nutrition/Chapter%203.1.5/refeeding-syndrome
gosh.nhs.uk/health-professionals/clinical-guidelines/refeeding-guidelines-children-and-young-people-feeding-and-eating-disorders-admitted-mildred-creak
denverhealth.org/medical-services/acute-center-for-eating-disorders/conditions-we-treat/refeeding-syndrome
glossary.feast-ed.org/3-treatment-medical-management/refeeding-syndrome
intensivedietarymanagement.com/refeeding-syndromes-fasting-20/

Last modified on July 7th, 2017 at 9:50 am

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