They are at even greater risk of precipitate falls in these circulating electrolytes once simultaneous nutritional and fluid therapy has started. Any discussion on the risks of the refeeding syndrome should include the increased threat of infection that may often be silent in malnutrition.1 Malnourished patients may develop infection without showing the usual septic markerssuch as an increased temperature, leucocyte count, or C reactive protein. These studies discussed ceasing NG feeds after the risk of RS had reduced; most gave a time frame between 2 and 14days [24, 44]. Results have shown that NG feeding is used commonly in the hospital setting to treat medical instability as a result of severe malnourishment, and in the specialist eating disorders (ED) unit due to failure to meet oral intake. Sodium (salt) replacement may also be carefully monitored. AHRQ publication no. The https:// ensures that you are connecting to the This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Fabio Bioletto: Data curation, Writing - Review & Editing. DOI: Mehanna HM, et al. Whenever possible, attempt to provide the. Fuller S, Street O, Hudson L, Nicholls D. Enteral feeding young people with anorexia nervosa under restraint in inpatient settings. Skrik Liever et al [44] reported 27% required NG feeding and linked this to a faster weight gain but gave no information related to NG feeding protocols. Patients who were older (OR 1.14 (95% CI 1.08; 1.21) per year added, p<0.001) and who had a higher Pediatric Risk of Mortality (PIM3) score had a higher risk of developing early RFH (OR 1.36 (95% CI 1.15; 1.59) per unit added, p<0.001), whereas patients in the late-PN group had a lower risk of early RFH (OR 0.24 (95% CI 0.10; 0.49), p<0.001). Electrolyte levels are monitored with frequent blood tests. Paediatr Child Health. Research on NG feeding in YP has tended to focus on the acute refeeding phase in paediatric or psychiatric wards to reduce the risk of RS [17]. The most common primary disease was cancer (n=267), followed by mesenteric ischemia (n=104), and surgical complications (n=62). statement and Other factors can also put you at an increased risk of developing refeeding syndrome. Conversely, Akgul and colleagues [36] described a much shorter average time, 2.5days, that YP required NG before transitioning to an oral diet. Less time spent being underfed may still result in refeeding syndrome if the patient were under, Abuse, neglect, inadequate access to food, Hyperemesis gravidarum or protracted vomiting, Malabsorption (e.g., inflammatory bowel disease, short gut syndrome, s/p bariatric surgery). All selected studies had an observational design, 23 were retrospective cohort studies [. Kristen Hindley. Finally, factors associated with the incidence of RFS, such as its definition, study design, type of population, age, initial caloric intake, and type of feeding were assessed by subgroup analysis. The potential risk of refeeding syndrome should be considered whenever starting any previously underfed patient on nutrition. Underweight or recent weight loss. Rhabdomyolysis can occur (causing an elevated creatinine kinase). BMJ Open. Int J Adolesc Med Health. Agostino and colleagues [23] demonstrated that YP on medical wards having NG feeds had a mean LOS of 33.8days compared to those in the same setting having an oral diet who had a mean of 50.9days, however, the oral diet was lower in calories therefore taking longer for weight recovery and medical stabilisation. https://doi.org/10.5694/j.1326-5377.2009.tb02487.x. Similar to the review conducted by Hale and Logomarsino [33] who found RS to be a rare complication, it is reassuring to find that no study in this review reported YP developing RS despite some studies starting on high calorie NG feeding plans [9, 18, 24, 42]. Due to the anticipated paucity of studies in this area any research where a meaningful conclusion or result can be drawn regarding NG use in YP with ED will be included. Previous studies indicate that the incidence of refeeding syndrome is relatively high [12], including electrolyte abnormalities with sodium-water retention, which may potentially lead to heart and respiratory failure, even death [11,13,14]. ASPEN Consensus Recommendations for Refeeding Syndrome This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidan Copyright 2009-. Leeds and York Partnership NHS Foundation Trust, Mill Lodge, 520 Huntington Rd, York, YO32 9QA, UK, You can also search for this author in Valentina Ponzo: Data curation, Writing - Review & Editing. Further research is required to assess which method is the safest, most efficacious and best aids transition back to a fully oral diet. It seems logical to avoid administering insulin if possible (e.g., allowing glucose to rise to ~200-300 mg/dL). This review describes the large differences in the use of NG for YP with ED in medical and psychiatric wards in a number of countries globally. WebRefeeding syndrome consists of metabolic changes that occur on the reintroduction of nutrition to in those who are malnourished or in the starved state (Figure 1).

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