Refeeding syndrome
Refeeding syndrome is a serious condition that can occur when a person who has been malnourished resumes eating. It is particularly common in individuals who have experienced starvation, those with eating disorders, and patients recovering from certain medical conditions or surgeries. When food is reintroduced, especially carbohydrates, the body must readjust its metabolic processes, which can lead to dangerous imbalances in electrolytes and hormones. Symptoms of refeeding syndrome may develop within four days of starting to eat again and can include weakness, confusion, breathing difficulties, and even life-threatening complications such as heart problems or seizures.
The risk factors for developing refeeding syndrome include a low body mass index (BMI), significant recent weight loss, prolonged food deprivation, and certain medical conditions or medication histories. Due to the unpredictable nature of the syndrome, individuals at risk are often hospitalized for careful monitoring and management of their nutritional intake and electrolyte levels. Treatment strategies emphasize a gradual refeeding process, proper fluid balance, and timely medical intervention to ensure safety. Interestingly, refeeding syndrome can also affect animals, particularly those that have been underfed, and the approach to their care mirrors that of humans. Understanding refeeding syndrome is essential for those involved in the care of individuals recovering from malnutrition to prevent potentially severe complications.
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Refeeding syndrome
Refeeding syndrome is a condition that can develop when a person who has been malnourished begins to eat again. People who have been starved by famine or other circumstances, those with eating disorders, those who have certain health conditions, and those who have had weight loss surgery are among the most at risk to develop the condition.
Refeeding syndrome is serious and can be life-threatening. The risk can be minimized by having medical supervision for refeeding. The syndrome can also occur in animals that have been severely underfed or endured prolonged lack of nutrition.
Background
When a person has not been eating or has been eating very little, the body changes its metabolism process. Metabolism converts food into fuel for the body. Healthy metabolism requires a number of components, including a fuel source, hormones, and electrolytes. The body manufactures hormones, while electrolytes occur in the body or can be ingested through food and supplements.
Normally, carbohydrates found in food are used as the primary fuel source for the body. However, when food intake is restricted and there are not enough carbohydrates to provide the fuel the body needs, the body turns to using stored protein and fats to survive. This change alters the balance of hormones and electrolytes. When food is reintroduced after metabolism has been altered in this way, it further upsets the balance of hormones and electrolytes and can cause problems with nearly all of the body’s systems. This is called refeeding syndrome.
When food is reintroduced, the patient is once again consuming carbohydrates. However, the body has adjusted to using protein and fat as a fuel supply. The change back to carbohydrates as fuel requires the body to adjust to sudden changes in important components of metabolism. These changes include unusual levels of sodium in body fluids, changes in hormones, and potentially serious deficiencies of magnesium, potassium, and thiamine.
Refeeding syndrome was first recognized in the 1940s. Physicians noted that recovered World War II prisoners of war who had been starved while imprisoned experienced problems when they began to eat again. Since that time, medical professionals have realized that the condition occurs with various levels of severity, ranging from mild symptoms detectable only by medical testing to death.
Overview
Not everyone has a problem restarting food after a long period of malnourishment. Physicians have not found a way to determine who will or will not have problems. When problems do occur, they usually begin within four days of the start of the refeeding process. The symptoms can include weakness, tiredness, confusion, difficulty breathing, high blood pressure, heart rhythm problems, heart attack, seizures, coma, and possibly death.
People who have gone with little or no food for as little as five days can be at risk of refeeding syndrome. It can occur after restriction of food because of fasting, extreme dieting, or malnourishment because of starvation, famine, or other cause. Patients with certain other medical conditions may also take in little food for long periods and be at risk of refeeding syndrome. These include conditions such as recent surgery, uncontrolled diabetes, cancer, eating disorders, alcoholism, or dysphagia (difficulty swallowing). In addition, people with a history of taking certain medications, such as antacids to control stomach acid and diuretics to help the body expel excess water, may also be at risk.
Although physicians cannot predict which at-risk individuals may develop refeeding syndrome, some people may be at higher risk. They include the following:
- Those with a body mass index (BMI) less than 16.
- Those who have lost more than 15 percent of their weight in less than six months.
- Those who have had little or no food for ten or more consecutive days.
- Those who have low blood levels of phosphate, potassium, or magnesium.
In addition, people who meet two of the following conditions may also experience a greater risk of refeeding syndrome:
- Those with a BMI under 18.5.
- Those who have lost 10 percent of body weight in less than six months.
- Those who have had little or no food for five or more consecutive days.
- Those who have a history of alcoholism or who use insulin, chemotherapy drugs, antacids, or diuretics.
Refeeding syndrome can cause significant and life-threatening symptoms to appear with little or no warning. As a result, those with identified risk factors are usually hospitalized for the refeeding process. This allows physicians to carefully monitor levels of key nutrients and electrolytes with frequent blood tests. It also provides quick access to any needed emergency treatments, increasing the likelihood that the patient can complete the refeeding process safely.
The type and kind of nutrition the patient receives will be monitored and adjusted. The medical team will carefully monitor electrolyte levels with blood tests. They may use a special line inserted into one of the patient’s veins to introduce intravenous (IV) fluids containing electrolytes to supplement the patient’s supply. Since body fluids contain electrolytes, the medical team may also monitor how much liquid the patient receives and how much is lost through urination. The patient will also be monitored for any developing heart problems, and may receive other tests based on the presence of other conditions such as kidney problems or abnormal levels of calcium in the body.
For those patients who do experience refeeding syndrome, recovery will depend on how severely they were affected and how quickly they receive medical attention. It may also depend in part on any underlying health conditions that complicate the refeeding process.
Experts say the best way to ensure a good outcome is to identify those at the greatest risk of experiencing refeeding syndrome and taking steps to minimize the risk. This can include reintroducing food slowly, monitoring fluid and electrolyte balances and supplementing as necessary, and preventing patients from developing malnutrition in the first place.
Humans are not the only beings to experience refeeding syndrome; it can also occur in animals. It can happen when an animal is underfed either through neglect or because of scarcity of food in an environment. Some of the same underlying medical conditions that increase the risk of refeeding syndrome in humans, such as cancer and diabetes, can also increase the risk for animals. Animals with refeeding syndrome are generally refed intravenously to increase chances of survival.
Bibliography
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