Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study

Alan Rio, Kevin Whelan, Louise Goff, Dianne Patricia Reidlinger, Nigel Smeeton

Research output: Contribution to journalArticleResearchpeer-review

64 Citations (Scopus)

Abstract

BACKGROUND: Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.

OBJECTIVE: To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.

DESIGN: Prospective cohort study.

SETTING: Large, single site university teaching hospital. Recruitment period 2007-2009.

PARTICIPANTS: 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.

MAIN OUTCOME MEASURES:

PRIMARY OUTCOME: occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.

RESULTS: 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.

CONCLUSIONS: Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.

Original languageEnglish
JournalBMJ Open
Volume3
Issue number1
DOIs
Publication statusPublished - 11 Jan 2013
Externally publishedYes

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Refeeding Syndrome
Cohort Studies
Prospective Studies
Magnesium
Electrolytes
Serum
Starvation
Alcoholism
Weight Loss
Mortality
Anorexia Nervosa
Critical Care

Cite this

@article{2fd0a57c3ffa46af8c78dd9c9cb35216,
title = "Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study",
abstract = "BACKGROUND: Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.OBJECTIVE: To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.DESIGN: Prospective cohort study.SETTING: Large, single site university teaching hospital. Recruitment period 2007-2009.PARTICIPANTS: 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.MAIN OUTCOME MEASURES: PRIMARY OUTCOME: occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.RESULTS: 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15{\%} in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15{\%} prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7{\%}: specificity was >80{\%} apart from weight loss of >15{\%} which was 59.1{\%}. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2{\%} 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3{\%} 13/243) participants died during the feeding period and (28{\%} 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.CONCLUSIONS: Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.",
author = "Alan Rio and Kevin Whelan and Louise Goff and Reidlinger, {Dianne Patricia} and Nigel Smeeton",
year = "2013",
month = "1",
day = "11",
doi = "10.1136/bmjopen-2012-002173",
language = "English",
volume = "3",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
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}

Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. / Rio, Alan; Whelan, Kevin; Goff, Louise; Reidlinger, Dianne Patricia; Smeeton, Nigel.

In: BMJ Open, Vol. 3, No. 1, 11.01.2013.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study

AU - Rio, Alan

AU - Whelan, Kevin

AU - Goff, Louise

AU - Reidlinger, Dianne Patricia

AU - Smeeton, Nigel

PY - 2013/1/11

Y1 - 2013/1/11

N2 - BACKGROUND: Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.OBJECTIVE: To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.DESIGN: Prospective cohort study.SETTING: Large, single site university teaching hospital. Recruitment period 2007-2009.PARTICIPANTS: 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.MAIN OUTCOME MEASURES: PRIMARY OUTCOME: occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.RESULTS: 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.CONCLUSIONS: Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.

AB - BACKGROUND: Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement.OBJECTIVE: To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support.DESIGN: Prospective cohort study.SETTING: Large, single site university teaching hospital. Recruitment period 2007-2009.PARTICIPANTS: 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care.MAIN OUTCOME MEASURES: PRIMARY OUTCOME: occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality.RESULTS: 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes.CONCLUSIONS: Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.

U2 - 10.1136/bmjopen-2012-002173

DO - 10.1136/bmjopen-2012-002173

M3 - Article

VL - 3

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

ER -