The refeeding syndrome. Importance of phosphorus

Med Clin (Barc). 2018 Jun 22;150(12):472-478. doi: 10.1016/j.medcli.2017.12.008. Epub 2018 Feb 12.
[Article in English, Spanish]

Abstract

Refeeding syndrome (RS) is a complex disease that occurs when nutritional support is initiated after a period of starvation. The hallmark feature is the hypophosphataemia, however other biochemical abnormalities like hypokalaemia, hypomagnesaemia, thiamine deficiency and disorder of sodium and fluid balance are common. The incidence of RS is unknown as no universally accepted definition exists, but it is frequently underdiagnosed. RS is a potentially fatal, but preventable, disorder. The identification of patients at risk is crucial to improve their management. If RS is diagnosed, there is one guideline (NICE 2006) in place to help its treatment (but it is based on low quality of evidence). The aims of this review are: highlight the importance of this problem in malnourished patients, discuss the pathophysiology and clinical characteristics, with a final series of recommendations to reduce the risk of the syndrome and facilitate the treatment.

Keywords: Ayuno; Hipofosfatemia; Hipomagnesemia; Hipopotasemia; Hypokalaemia; Hypomagnesaemia; Hypophosphataemia; Prevención; Prevention; Refeeding syndrome; Starvation; Síndrome de realimentación.

Publication types

  • Review

MeSH terms

  • Anorexia Nervosa / complications
  • Anorexia Nervosa / therapy
  • Early Diagnosis
  • Energy Metabolism
  • Humans
  • Hypokalemia / etiology
  • Hypophosphatemia / etiology
  • Incidence
  • Magnesium Deficiency / etiology
  • Malnutrition / complications
  • Malnutrition / therapy
  • Nutritional Support / adverse effects*
  • Phosphorus / blood
  • Practice Guidelines as Topic
  • Refeeding Syndrome* / epidemiology
  • Refeeding Syndrome* / etiology
  • Refeeding Syndrome* / metabolism
  • Refeeding Syndrome* / prevention & control
  • Thiamine Deficiency / etiology
  • Water-Electrolyte Imbalance / etiology

Substances

  • Phosphorus