Refeeding Syndrome– This is an extremely serious pathological condition in which a malnourished individual starts receiving feeding again, which may cause serious metabolic and hormonal changes which can be potentially fatal in some cases.
How Do We Define Refeeding Syndrome?
Refeeding Syndrome can be described as modifications in the amount of fluid and electrolytes in the body which can be potentially fatal at times, which usually occurs in malnourished individuals who start receiving feeding again either through the mouth or intravenously/enterally. These modifications occur as a result of metabolic and hormonal changes and may have serious implications on the overall health of the individual. The main feature of Refeeding Syndrome is the development of hypophosphatemia, although Refeeding Syndrome is quite complex and also features sodium and fluid imbalance; alterations in the levels of glucose and protein, metabolism of fats; hypokalemia as well as hypomagnesaemia.
Causes of Refeeding Syndrome
Majority of the times Refeeding Syndrome is caused by prolonged fasting, as when the refeeding process begins it may cause rapid metabolic and hormonal alterations. As a result of prolonged fasting, the body starts using fat and proteins as a source for energy instead of the carbohydrates and basal metabolic rate comes down by an alarming 25%.
Symptoms Of Refeeding Syndrome
It is quite unfortunate but early signs of Refeeding Syndrome tend to get overlooked as they are very nonspecific. However there are certain symptoms that are associated with Refeeding Syndrome and they are:
- Generalized weakness
- Seizures
- Muscle fiber breakdown
- WBC dysfunction
- Hypotension
- Respiratory failure
- Arrhythmia
- Cardiac arrest
Diagnosis of Refeeding Syndrome
Refeeding Syndrome Can Be Diagnosed By Observing For The Following:
- Extremely low BMI (Usually less than 15)
- Rapid loss of weight
- Very little intake of food for about a week to a fortnight
- Depleted levels of potassium, phosphates, and/or magnesium before beginning refeeding
Treatment For Refeeding Syndrome
Refeeding Syndrome can become fatal if it is not identified and treated in a timely fashion, hence appropriate awareness of the condition is imperative for early diagnosis. Refeeding Syndrome is found mostly in people who lose weight rapidly due to malnourishment and Refeeding Syndrome can develop quite rapidly within a short period of time of refeeding hence close monitoring for metabolic changes is imperative when refeeding process is on. The first choice for refeeding is milk as it is high in phosphates and is tolerated quite easily.
In cases the levels of potassium, phosphates, magnesium is severely depleted then corrective measures should be undertaken and use of thiamine, vitamin B, and multivitamins is strongly advised.
Individuals who have not had oral intake of food for quite some time or have been fasting for a prolonged period of time suffer from GI disturbance at the time of refeeding with complaints of abdominal pain, reflux, nausea etc.. This can be addressed by giving medications like metoclopramide and acid suppressants like omeprazole.
Prevention of Refeeding Syndrome
Refeeding Syndrome can be identified by the above mentioned criteria and in case Refeeding Syndrome is identified then the rate of refeeding should be slow and the electrolyte imbalance should be corrected. There should be active involvement of a special diet team.
