There is no validated method to assess the retrospective and qualitative nature of studies included therefore we could not conduct a formal quality assessment or statistical method to evaluate the results. Bethesda, MD 20894, Web Policies Shifts in electrolyte levels can cause serious complications, including seizures, heart failure, and comas. 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. British Dietetic Association. A review conducted by Rizzo and colleagues [49] (2019), which focused on NG for acute refeeding, also found a wide variety of practices. Further research is warranted to determine whether refeeding syndrome prolongs the length of stay, and to verify the effect of different energy intakes during refeeding on the length of stay in people with malnutrition. If this is tolerated, continue to gradually increase intake up to full nutritional support. The PRISMA flowchart was used (Fig. Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. Nutritional glucose intake affects blood glucose (BG) outcomes, but few protocols actively control it. official website and that any information you provide is encrypted Our website services, content, and products are for informational purposes only. DOI: hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf, med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-16.pdf. Agostino et al [23] compared a higher calorie (1500-1800kcal/d) continuous NG fed cohort to lower calorie oral bolus cohort (1000-1200kcal/d, divided 6 times per day), results showed mean weight gain was greater in the continuous NG fed group (1.22 kgs per week) than the oral bolus fed group (0.08 kgs per week) over the first 2weeks. Only 52% of studies were conducted prospectively. For example, in Australian studies medical wards tended to include high levels of psychiatric treatment alongside medical treatment [26]. The optimal cutoff is unclear, possibly an absolute serum phosphate level below ~1.5 mg/dL (0.5 mM). However, there is no high-quality evidence that this reduces the risk of refeeding syndrome. We noted that despite RH being common in inpatients with PEM+TB given high caloric diets, RFS was not detected. Patients Cut back rate of nutrition (e.g., 25-50% of usual caloric target, depending on severity). Learn the difference between these two conditions. The duration of underfeeding is typically >7-10 days. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. As a result, prevention is critical. All rights reserved. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach. The majority also had a relatively small sample size, again introducing the possibility of bias and reducing generalizability. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? 2017;22(5):26972. Despite this, the patient encountered refeeding syndrome with significant electrolyte STAR GC is most effective when nutrition and insulin are modulated together with timely responsiveness to persistent hyperglycaemia. Strik Lievers L, Curt F, Wallier J, Perdereau F, Rein Z, Jeammet P, et al. Akgul S, Akdemir DP, Kara M, Derman O, OCetin FC, Kabbur N. The understanding of risk factors for eating disorders in male adolescents. Studies using bolus feeds stated that oral intake was encouraged and it was only when this was not fully achieved that supplementary NG was used [39]. 2016;58(6):6419. JAMA Pediatr; doi: 10.1001/jamapediatrics.2020.3359Investigators from multiple This has resulted in a variety of NG feeding practices across different settings, with many medical wards tending to provide continuous NG feeds and cease oral intake in order to medically stabilise the patient [20, 22,23,24,25,26]; in contrast mental health wards or specialized eating disorder programs housed on medical wards may be more likely to use syringe bolus feeds to provide food when meals are refused, encouraging oral intake and aiding normalisation of eating [9, 18, 27,28,29,30,31]. Fiber intake depends on age, gender, and sex. Petkova BH, Simic M, Nicholls D, Ford T, Prina AM, Stuart R. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. A blood test that reveals low levels of phosphorus, potassium or magnesium. Refeeding Syndrome: Prevention and Management Sydney Childrens Hospital Practice, Guideline June 2013 Crook MA. Underweight or recent weight loss. Fabio Bioletto: Data curation, Writing - Review & Editing. Rizo S, Douglas JW, Lawrence JC. The pooled impact of refeeding syndrome on length of stay of 2634 patients in 10 studies was weighted mean difference (WMD)=2.91 (95% CI,0.18 6.00; P=0.065) days. 1. 2023 BioMed Central Ltd unless otherwise stated. The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe You have a history of alcohol use disorder or use of certain medications, such as insulin, chemotherapy drugs, diuretics, or antacids. Patients with restrictive eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS), are predominantly female (91%) and Caucasian (92%), with incidence being approximately 0.014 for females [3]. Patients at high risk of the syndrome may also be at risk of acute renal failure, which may be missed as they have only slightly raised urea and creatinine measurements because of low muscle mass, leading to low production of these metabolites. HHS Vulnerability Disclosure, Help Both these pathways are dysregulated in acute stress, but the magnitude of this deregulation cannot be assessed in clinical practice. Am J Psychiatry. To evaluate the influence of the SMI and MRA on post-surgery complications, logistic regression models were used. 2019. By continuing you agree to the use of cookies. Myers E, McCrory D, Mills A, et al. Follow lytes including Mg & Phosphate for three days. WebIf the patient is considered to be at high risk of refeeding syndrome, the following steps are advised by NICE:1 Start nutrition support at a maximum of 10 kcal/kg/day, increasing levels slowly to meet or exceed full needs by four to seven days. Conversely the YP in Paccagnella and colleagues [20] research stated NG was helpful, particularly initially when an oral diet was challenging to manage. Overall, 39% (57/146) of all responders thought the guidance represented safe practice, whereas 36% (53/146) thought they were excessively cautious. All authors have reviewed the document and consent to publication. 2011;19:52630. Silber TJ, Robb AS, Orrell-Valente JK, Ellis N, Valadez-Meltzer A, Dadson MJ. However, this new definition may be insufficiently specific for clinically relevent electrolyte changes and requires clinical validation. They concluded that the requirement for NG was an indication of severity and resistance to oral feeding [44]. Manage cookies/Do not sell my data we use in the preference centre. Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). McCray S, et al. Couturier and Mahmood [29] highlighted that meal support therapy reduced the requirement for NG feeding from 66.7 to 11.1%, criteria for NG feeding was the same in both groups throughout and oral intake was encouraged. This site represents our opinions only. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. The subjects at risk of developing RFS are characterized by reduced insulin secretion and increased glucagon release, with a metabolic shift towards the utilization as energy sources of proteins and fats instead of glucose with resulting muscle mass loss, and a decrease in intracellular vitamins and minerals, particularly phosphate, potassium, and magnesium, due to undernutrition [4]. (2004). This systematic review sets out to In a recent systematic review [32] 9/10 studies in hospitalised ED patients are given continuous or overnight supplemental NG feeding. Overall, this review found 5 studies [9, 18, 23, 24, 29] reported some incidence of electrolyte disturbance, 2 studies [29, 39] described epistaxis and 1 study [39] described behavioural problems associated with the procedure. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Webreport, literature review and clinical guidelines. Wernicke encephalopathy (ocular abnormalities, ataxia, delirium), Weakness (including respiratory muscle weakness). Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, et al. As such, this might be most accurately termed carbohydrate refeeding syndrome.. The reintroduction of enteral or parenteral nutrition, leading to refeeding hypophosphatemia (RFH), has been presented as potential risk factor. Glycaemic control (GC) may improve outcomes, though safe and effective control has proven elusive. Best C. How to set up and administer an enteral feed via a nasogastric tube. Recovering from refeeding syndrome depends on the severity of malnourishment before food was reintroduced. 2013;39(2):8593. However, this will be the first systematic review on the use of NG feeding specifically in YP with ED. Three studies reported weight gain in the context of inadequate oral intake [9, 18, 39]. Am J Psychiatry. Source: Garber AK, Cheng J, Accurso EC, et al. The National Institute for Clinical Excellence has produced guidance for providing nutrition recommending a graded approach [15]. It is probable that medical wards primarily manage YP for short periods to stabilise acute physical health deterioration, while MH wards admit relatively medically stable YP and seek primarily to treat psychological ED symptoms that are preventing an adequate oral diet. https://doi.org/10.1002/ncp.10187. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18years. Patient profile, clinical course and treatment outcomes were assessed. clos Nutritional care pathway (NICE, 2006, BAPEN, 2007) Screen for malnutrition (using MUST screening tool) refeeding syndrome: 25-35 kcal/kg/day total energy INCLUDING that derived from protein 0.8 Additionally, the combination of plasma butyric acid levels and HIF3A intron 1 methylation at CpG 6 discriminated DCM patients from type2 diabetes mellitus (T2DM) patients. This is a secondary analysis of the PEPaNIC randomized controlled trial (N=1440), which showed that withholding supplemental parenteral nutrition (PN) for 1 week (late-PN) in the pediatric intensive care unit (PICU) accelerated recovery and reduced new infections compared to early-PN (<24h). From beginners to advanced, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Previous reviews [32, 33] have examined use of NG feeding in ED, including the safety and efficacy of NG feeding as well as short-term and long-term outcomes. 2 of these studies [24, 26] for the first 2472h started with continuous NG feeding, using higher than standard calorie protocols, 24003000kcal per day prevented any initial drop in weight. There is a need for more high quality data in when to initiate NG, comparing different methods of delivering NG feeds and transitioning from NG to oral diet in YP with restrictive ED to enable future direction for clinicians. A survey of dietitians found 82% considered NG feeding a necessary procedure if oral diet is inadequate [10]. Paediatr Child Health. Halse C, Broughtwood D, Clarke S, Honey A, Kohn M, Madden S. Illumating multiple perspectives: meaning of nasogastric feeding in anorexia nervosa. London: National Institute for a Clinical Excellence; 2004. The potential risk of refeeding syndrome should be considered whenever starting any previously underfed patient on nutrition. Yet again, the incidence is 1 Malnourished This systematic review sets out to review the current reported evidence of NG in young people. Studies published in languages other than English were translated prior to being reviewed. To examine the impact of nutritional intake on phosphate concentrations, structural nested mean models with propensity score and censoring models were used. By using this website, you agree to our 2005;13(4):26472. Nutritional rehabilitation is central to achieving medical stabilization. NOTE: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. If the SMI increased, the odds for pleural effusion and pleural empyema decreased, but the odds of a pulmonary embolism increased. The incidence of RFS varied from 0% to 62% across the studies. Hypophosphatemia during critical illness has been associated with adverse outcome. Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a lifesaving treatment. Although there is a significant body of research into this, the role of NG feeding remains ill-defined [17]. J Adolesc Health. RH was found in 37% (10/27). Medical wards used continuous feeding more frequently than MH wards, however this tended to be for a short period of time while the YP was medically unstable, after this they would be transitioned to an oral diet [22, 23, 25, 26]. The WebThe NICE (National Institute for Health and Clinical Excellence) in England has listed criteria for identifying a patient who may be at increased risk for refeeding problems. It comes after a rigorous review process. Royal Collage of Psychiatry. Kwashiorkor and Marasmus: Whats the Difference? Madden S, Miskovic-Wheatley J, Wallis A, et al. When NG feeding is used under restraint bolus feeds are preferred due to concerns around the tube being removed by the YP once restraint had ceased [45]. This phenomenon is therefore also known as refeeding hypophosphatemia (RFH) [1517]. DOI: Hearing SD. Restore circulatory volume and monitor fluid balance and overall clinical status closely. 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. Med J Aust. The American Society of Parenteral and Enteral Nutrition (ASPEN) has proposed the definition of refeeding syndrome shown below (32115791). NICE guidelines regarding refeeding syndrome, based on a very cautious refeeding regime reaching estimated calorie and protein needs within 7 days, compared 2018;33(6):7905. PubMed Accessibility There are clear risk factors for refeeding syndrome. Patients at risk for refeeding syndrome should be treated in the hospital setting due to the need for frequent laboratory monitoring. Valentina Ponzo: Data curation, Writing - Review & Editing. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa. These changes determine a further depletion of the mineral and vitamin pool (with depletion of ATP), a decrease in urinary sodium and water excretion, and a rapid fluid overload that can lead to congestive cardiac failure, respiratory failure, and impairment in many physiological processes up to death [4,6]. It includes gluconeogenesis (GNG) from non-carbohydrate substrates and hepatic glycogenolysis.