Further evidence to throw caution to the wind: outcomes using an assertive approach to manage refeeding syndrome risk

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.

Automated summary

This study examined the nutritional management and outcomes of patients at risk of refeeding syndrome (RFS) after implementing updated guidelines. The results suggest that liberal RFS guidelines appear to be safe, and further research on liberalized refeeding protocols may be useful for updating international guidelines.