Refeeding syndrome after malnutrition is a serious complication that can be prevented. According to a 2005 article in "The Medical Journal of Australia," refeeding syndrome describes severe electrolyte, fluid and metabolic abnormalities that occur in malnourished patients after renutrition. Therefore, malnourished patients who are at risk should be identified early in treatment to prevent this serious complication.
History
A 2004 article in the "British Medical Journal" describes the history of refeeding syndrome. Stephen Hearing states that refeeding syndrome was first described in Japanese prisoners during World War II. They were starved and began eating again when they were freed. As they began increasing their caloric intake, many went into cardiac failure. Further research into the pathophysiology of eating after a prolonged period of starvation was necessary to determine the cause of cardiac failure.
Cause
According to the "British Medical Journal," insulin is decreased in the blood stream in a response to a decrease in carbohydrate intake. Because no carbohydrates are available for energy, fat and protein are metabolized. This causes a decrease in phosphate inside cells, although phosphate levels in the blood stream may be normal. When eating resumes, insulin is produced, which forces most of the phosphate in the blood stream to move into cells. This process results in profound hypophosphatemia, or low blood phosphate, which can be fatal.
Complications
Refeeding syndrome and low blood phosphate commonly occur four days after renutrition, according to the "British Medical Journal." Because phosphate is necessary for energy production and many necessary chemical reactions, low levels may cause muscle breakdown, immune system dysfunction, low blood pressure, heart failure, respiratory failure, irregular heartbeat, seizures, coma and death. Identifying symptoms of the syndrome may be difficult, but phosphate levels should be checked if any abnormal signs or symptoms occur once a patient begins eating again.
Treatment
The proper treatment of refeeding syndrome is necessary to prevent serious complications. According to "The Medical Journal of Australia," intravenous phosphate is needed to replace low body phosphate stores, as oral intake of a phosphate supplement is inadequate. In addition, thiamine and potassium supplementation is necessary. A low-calorie diet must be prescribed to prevent worsening complications. Consult a dietitian for management of malnourished patients.
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