Further evidence to throw caution to the wind: outcomes using an assertive approach to manage refeeding syndrome risk.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
02
02
2020
accepted:
25
06
2020
revised:
04
06
2020
pubmed:
6
7
2020
medline:
8
7
2021
entrez:
6
7
2020
Statut:
ppublish
Résumé
Refeeding syndrome (RFS) can occur in severely malnourished or starved populations that are provided with rapid or unbalanced nutrition. International guidelines recommend a cautious approach for managing RFS risk (hypocaloric nutrition for 4-7 days), however emerging evidence supports a more assertive approach. This study aimed to describe nutritional management and RFS-related adverse outcomes in patients at risk of RFS receiving care after implementing updated guidelines reflecting emerging evidence. A retrospective cohort study of inpatients at risk of RFS during admission to a large metropolitan hospital in Queensland, Australia between November 2018 and April 2019 was conducted. Data were collected from medical records on nutritional management (provision of nutrition, electrolyte, and vitamin replacement) and outcomes (incidence of RFS, serum electrolyte decreases, hypo/hyperglycaemia, oedema, and organ function disturbance). Data were analysed descriptively; relationships between serum electrolyte decreases and nutrition management were explored using Fisher's Exact tests. Of the 70 patients identified at risk of RFS (58.4 ± 16.8 years, 56% male, 94% malnourished), majority of participants received required supplementation prior to the commencement of nutrition (thiamine: 76%; micronutrients: 72-100%; multivitamin: 61%) and a standard initial nutrition management plan (79%; cautious: 13%; liberal: 8%). There were no cases of RFS. Four participants experienced RFS-related adverse outcomes (severe electrolyte decreases: n = 2, hypo/hyperglycaemia: n = 2); however, there was no differences in serum electrolyte decreases based on the nutrition management plan (initial: p = 0.912; goal: p = 0.688). The implementation of more liberal RFS guidelines for the management of RFS risk appears to be safe. Further research examining liberalised refeeding protocols may be useful in updating international guidelines.
Sections du résumé
BACKGROUND/OBJECTIVES
Refeeding syndrome (RFS) can occur in severely malnourished or starved populations that are provided with rapid or unbalanced nutrition. International guidelines recommend a cautious approach for managing RFS risk (hypocaloric nutrition for 4-7 days), however emerging evidence supports a more assertive approach. This study aimed to describe nutritional management and RFS-related adverse outcomes in patients at risk of RFS receiving care after implementing updated guidelines reflecting emerging evidence.
SUBJECTS/METHODS
A retrospective cohort study of inpatients at risk of RFS during admission to a large metropolitan hospital in Queensland, Australia between November 2018 and April 2019 was conducted. Data were collected from medical records on nutritional management (provision of nutrition, electrolyte, and vitamin replacement) and outcomes (incidence of RFS, serum electrolyte decreases, hypo/hyperglycaemia, oedema, and organ function disturbance). Data were analysed descriptively; relationships between serum electrolyte decreases and nutrition management were explored using Fisher's Exact tests.
RESULTS
Of the 70 patients identified at risk of RFS (58.4 ± 16.8 years, 56% male, 94% malnourished), majority of participants received required supplementation prior to the commencement of nutrition (thiamine: 76%; micronutrients: 72-100%; multivitamin: 61%) and a standard initial nutrition management plan (79%; cautious: 13%; liberal: 8%). There were no cases of RFS. Four participants experienced RFS-related adverse outcomes (severe electrolyte decreases: n = 2, hypo/hyperglycaemia: n = 2); however, there was no differences in serum electrolyte decreases based on the nutrition management plan (initial: p = 0.912; goal: p = 0.688).
CONCLUSIONS
The implementation of more liberal RFS guidelines for the management of RFS risk appears to be safe. Further research examining liberalised refeeding protocols may be useful in updating international guidelines.
Identifiants
pubmed: 32623441
doi: 10.1038/s41430-020-0676-6
pii: 10.1038/s41430-020-0676-6
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
91-98Références
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