Article information
Abstract
Refeeding syndrome is a complex syndrome that occurs as a result of reintroducing nutrition (oral, enteral, or parenteral) to patients who are starved or malnourished. Patients can develop fluid-balance abnormalities, electrolyte disorders (hypophosphataemia, hypokalaemia, and hypomagnesaemia), abnormal glucose metabolism, and certain vitamin deficiencies. Refeeding syndrome encompasses abnormalities affecting multiple organ systems, including neurological, pulmonary, cardiac, neuromuscular, and haematological functions. Pathogenic mechanisms involved in the refeeding syndrome and clinical manifestations have been reviewed. We provide suggestions for the prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk, reintroduce nutrition cautiously and correct electrolyte and vitamin deficiencies properly.
Keywords:
Refeeding syndrome
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Thiamine
Resumen
El síndrome de realimentación (SR) es un cuadro clínico complejo que ocurre como consecuencia de la reintroducción de la nutrición (oral, enteral o parenteral) en pacientes malnutridos. Los pacientes presentan trastornos en el balance de fluidos, anomalías electrolíticas —como hipofosfatemia, hipopotasemia e hipomagnesemia— alteraciones en el metabolismo hidrocarbonado y déficits vitamínicos. Esto se traduce en la aparición de complicaciones neurológicas, respiratorias, cardíacas, neuromusculares y hematológicas. En este artículo se han revisado la patogenia y las características clínicas del SR, haciendo alguna sugerencia para su prevención y tratamiento. Lo más importante en la prevención del SR es identificar a los pacientes en riesgo, instaurar el soporte nutricional de forma prudente y realizar una corrección adecuada de los déficits de electrolitos y vitaminas.
Palabras clave:
Síndrome de realimentación
Hipofosfatemia
Hipopotasemia
Hipomagnesemia
Tiamina
Full text is only available in PDF
References
[1.]
M.D. Kraft, I.F. Btaiche, G.S. Sacks.
Review of the refeeding syndrome.
Nutr Clin Pract, 20 (2005), pp. 625-633
[2.]
M.A. Crook, V. Hally, J.V. Panteli.
The importance of refeeding syndrome.
Nutrition, 17 (2001), pp. 632-637
[3.]
S.M. Solomon, D.F. Kirgy.
The refeeding syndrome: a review.
JPEN J Parenter Enteral Nutr., 14 (1990), pp. 90-97
[5.]
J. Brozek, C.B. Chapman, A. Keys.
Drastic food restriction: Effect on cardiovascular dynamics in normotensive and hypertensive conditions.
JAMA, 137 (1948), pp. 1569-1574
[6.]
R.L. Weinsier, C.L. Krumdieck.
Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited.
Am J Clin Nutr, 34 (1980), pp. 393-399
[7.]
J.C. Hernández Aranda, B. Gallo-Chico, M.L. Luna-Cruz, M.I. Rayon-Gonzalez, L.A. Flores-Ramirez, R. Ramos Muñoz, et al.
Desnutrición y nutrición parenteral total: estudio de una cohorte para determinar la incidencia del síndrome de realimentación.
Rev Gastroenterol Mex, 62 (1997), pp. 260-265
[8.]
A.G. González, A. Fajardo-Rodriguez, E. Gonzalez-Figueroa.
The incidente of the refeeding syndrome in cancer patients who receive artificial nutricional treatment.
Nutr Hosp, 11 (1996), pp. 98
[9.]
M.E. Flesher, K.A. Archer, B.D. Leslie, R.A. McCollom, G.P. Martinka.
Assesing the metabolic and clinical consequences of early enteral feeding in the malnourished patient.
JPEN J Parenter Enteral Nutr, 29 (2005), pp. 108-117
[10.]
J. Halevy, S. Bulvik.
Severe hypophosphatemia in hospitalised patients.
Arch Intern Med, 148 (1988), pp. 153-155
[11.]
P.E. Marik, M.K. Bedigian.
Refeeding hypophosphatemia in critically ill patients in an intensive care unit: a prospective study.
Arch Surg, 131 (1996), pp. 1043-1047
[12.]
E.B. Marliss, T.T. Aoki, R.H. Unger, J.S. Soeldner, G.F. Canill Jr..
Glucagon levels and metabolic effects in fasting man.
J Clin Invest, 49 (1970), pp. 2256-2270
[13.]
R.S. McDonald, R.J. Smith.
Starvation.
Principles and practice of endocrinology and metabolism, pp. 1247-1251
[14.]
S. Klein, J.F. Horowitz, M. Landt, S.J. Goodrick, V. Mohamed Ali, S.W. Coppack.
Leptin production during early starvation in lean and obese women.
Am J Physiol Endoc Metab, 278 (2000), pp. E280-E284
[15.]
R. Matz.
Parallels between treated uncontrolled diabetes and the refeeding syndrome with emphasis on fluid and electrolyte abnormalities.
Diabetes Care, 17 (1994), pp. 1209-1213
[16.]
R.A. DeFronzo, C.R. Cooke, R. Andres, G.R. Faloona, P.J. Davis.
The effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man.
J Clin Invest, 55 (1975), pp. 845-855
[17.]
C.W. Van Way, M. Longoria, G.S. Sacks.
Do surgeons need to worry about vitamin deficiencies?.
Nutr Clin Pract, 16 (2001), pp. S5-S7
[18.]
E. Danforth Jr., E.S. Horton, M. O’Connell, E.A. Sims, A.G. Burger, S.H. Ingbar, et al.
Dietary-induced alterations in thyroid hormone metabolism during overnutrition.
J Clin Invest, 64 (1979), pp. 1336-1347
[19.]
G.A. Bray, D.A. Fisher, I.J. Chopra.
Relation of thyroid hormones to body-weight.
Lancet, 1 (1976), pp. 1206
[20.]
J.R. Weisinger, E. Bellorin-Font.
Magnesium and phosphorus.
Lancet, 352 (1998), pp. 391-396
[21.]
M.P. Peppers, M. Geheb, T. Desai.
Hypophosphataemia and hyperphosphataemia.
Crit Care Clin, 7 (1991), pp. 201
[22.]
J.P. Knochel.
The pathophysiology and clinical characteristics of severe hypophosphataemia.
Arch Intern Med, 137 (1997), pp. 203
[23.]
D. Bacic, N. Shulz, J. Biber, B. Kaissling, H. Murer, C.A. Wagner.
Involvement of MAPK-kinase pathway in the PTH-mediated regulation of the proximal tubule type II Na + /Pi cotransporter in mouse kidney.
Pflugers Arch, 446 (2003), pp. 52-60
[24.]
K. Romesh.
Refeeding syndrome and hypophosphatemia.
J Inten Care Med, 20 (2005), pp. 174-175
[25.]
K. Kurikawa, B.S. Levine, D.B.N. Lee, S.G. Massry.
Fluid, electrolyte and acid-base disorders, pp. 625
[26.]
J.L. Temprano Ferreras, I. Breton Lesmes, C. De la Cuerda Compés, M. Camblor Alvarez, A. Zugasti Murillo, P. García Peris.
Síndrome de realimentación.
Revisión. Rev Clin Esp, 205 (2005), pp. 79-86
[27.]
D.R.H. Gourley.
The role of adenosine triphosphate of phosphate in the human erythrocyte.
Arch Biochem Biophys, 40 (1952), pp. 1
[28.]
T.G. Baumgartner.
Phosphate.
Clinical guide to parenteral micronutrition, pp. 77-100
[29.]
L.R. O’Connor, W.S. Wheeler, J.E. Bethune.
Effect of hypophosphatemia on myocardial performance in man.
N Engl J Med, 297 (1977), pp. 901-903
[30.]
Y.L. Huang, C.T. Fang, M.C. Tseng, Y.J. Lee, M.B. Lee.
Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient.
J Formos Med Assoc, 100 (2001), pp. 343-346
[31.]
L.Y. Vaszar, J.A. Culpepper-Morgan, S.M. Winter.
Refeeding syndrome induced by cautious enteral alimentation of a moderately malnourished patient.
Gastroenterologist, 6 (1998), pp. 79-81
[32.]
R. Subramanian, R. Khardori.
Severe hypophosphatemia: pathophysiologic implications, clinical presentations, and treatment.
Medicine, 79 (2000), pp. 1-8
[33.]
M. Aubier, D. Murciano, Y. Lecocguic, R. Pariente.
Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure.
N Engl J Med, 313 (1985), pp. 420-424
[34.]
M. Crook.
Hypophosphataemia and hypokalaemia in patients with hypomagnesaemia.
Br J Biomed Sci, 51 (1994), pp. 24-27
[36.]
P. Silva, R.S. Brown, F.H. Epstein.
Adaptation to potassium.
Kidney Int, 11 (1997), pp. 466
[38.]
J.R. Weisinger, E. Bellorin-Font.
Magnesium and phosphorous.
Lancet, 352 (1998), pp. 391-396
[39.]
J.B. Reuler, D.E. Girard, T.G. Cooney.
Wernicke's encephalopathy.
N Engl J Med, 312 (1985), pp. 1035-1039
[40.]
S.B. Heymsfield, R.A. Bethel, J.D. Ansley, D.M. Gibbs, J.M. Felner, D.O. Nutter.
Cardiac abnormalities in cachetic patients before and during nutritional repletion.
Am Hear t J, 95 (1978), pp. 584-594
[41.]
Z. Stanga, A. Brunner, M. Leuenberger, R.F. Grimble, A. Shenkin, S.P. Allison, D.N. Lobo.
Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment.
Eur J Clin Nutr, 62 (2008), pp. 687-694
[42.]
C.M. Apovian, M.M. McMahon, B.R. Bistran.
Guidelines for refeeding the marasmic patient.
Crit Care Med, 18 (1990), pp. 1030-1033
[43.]
N.A. Marinella.
The refeeding syndrome and hypophosphatemia.
Nutr Rev, 61 (2003), pp. 320-323
[44.]
C.L. Clark, G.S. Sacks, R.N. Dickerson, K.A. Kudsk, R.O. Brown.
Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial.
Crit Care Med, 23 (1995), pp. 1504-1511
[45.]
K. Dwyer, J.E. Barone, J.F. Rogers.
Severe hypophosphatemia in postoperative patients.
Nutr Clin Pract, 98 (1998), pp. 795-806
[46.]
M.A. Crook, V. Hally, J.V. Panteli.
The importance of the refeeding syndrome.
Nutrition, 17 (2001), pp. 632-637
[47.]
A.F. Jolly, R. Blank.
Refeeding syndrome.
Nutrition in clinical care, pp. 765-782
[48.]
J.R. Oster, M. Epstein.
Management of magnesium depletion.
Am J Nephrol, 8 (1988), pp. 349-354
[49.]
R.A. Reinhart.
Magnesium metabolism: a review with special reference to relationship between intracellular content and serum levels.
Arch Intern Med, 148 (1988), pp. 2415-2420
Copyright © 2009. Sociedad Española de Farmacia Hospitalaria
