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Refeeding Syndrome Diagnostic Challenges and the Potential of Clinical Decision Support Systems

DEUTSCHES ARZTEBLATT INTERNATIONAL (2023)

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Review Medicine, General & Internal

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

Valentina Ponzo et al.

Summary: Refeeding syndrome is a potentially serious condition that occurs in individuals who are rapidly fed after severe undernourishment, leading to abnormal electrolyte and fluid shifts which can cause organ dysfunctions. The lack of a standard definition and the nonspecificity of symptoms make diagnosis and estimation of incidence challenging. A unified definition and severity classification proposed by ASPEN in 2020 aim to raise awareness of the condition for better patient identification and prevention.

INTERNAL AND EMERGENCY MEDICINE (2021)

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Article Pediatrics

Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa A Multicenter Randomized Clinical Trial

Andrea K. Garber et al.

Summary: This study compared the short-term efficacy, safety, and cost of lower-calorie vs higher-calorie refeeding for malnourished adolescents and young adults with anorexia nervosa. The results showed that higher-calorie refeeding restored medical stability significantly earlier than lower-calorie refeeding, with no increase in safety events during hospitalization, and also resulted in shorter hospital stay and cost savings.

JAMA PEDIATRICS (2021)

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Article Rheumatology

Refeeding syndrome Pathophysiology, treatment and which rheumatic patients are particularly at risk

P. Nguyen et al.

Summary: Rheumatic diseases can lead to malnutrition, which in turn can cause life-threatening complications if not managed properly. Refeeding syndrome, a metabolic disturbance, can occur after reconstitution of nutrition, but can be prevented through adequate monitoring and supplementation.

ZEITSCHRIFT FUR RHEUMATOLOGIE (2021)

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Review Medicine, General & Internal

Impact of Refeeding Syndrome on Short- and Medium-Term All-Cause Mortality: A Systematic Review and Meta-Analysis

Fabio Bioletto et al.

Summary: This meta-analysis found a nonsignificant trend towards increased mortality in the short term for patients developing refeeding syndrome, especially in studies where renutrition was not prescribed or supervised by a nutritional support team. However, medium-term mortality showed a significantly higher risk associated with refeeding syndrome. Supervision and management of the refeeding process by a nutrition specialist may play a key role in limiting this mortality excess.

AMERICAN JOURNAL OF MEDICINE (2021)

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Review Nutrition & Dietetics

The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature

Iolanda Cioffi et al.

Summary: The incidence rates of refeeding syndrome (RFS) and refeeding hypophosphatemia (RH) varied significantly according to the definitions used and the populations analyzed, with higher rates observed in ICU inpatients and those with increased initial caloric intake. A universally accepted definition for RFS is needed to better characterize the syndrome and its management.

CLINICAL NUTRITION (2021)

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Article Pediatrics

Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial

Neville H. Golden et al.

Summary: This randomized controlled trial found that there were no significant differences in clinical remission rates and medical rehospitalization rates between higher-calorie refeeding (HCR) and lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa over a one-year period.

PEDIATRICS (2021)

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Article Medical Informatics

The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation

Maria Beatriz Walter Costa et al.

Summary: This study aimed to implement and evaluate a CDSS that supports healthcare professionals and improves patient safety. The system, named AMPEL, has been developed to notify healthcare professionals of life-threatening medical conditions and is currently running 5 different algorithms. AMPEL enables continuous surveillance of patients and has the capacity for many more algorithms, with the hope of encouraging colleagues to implement similar CDSS.

JMIR MEDICAL INFORMATICS (2021)

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Article Medicine, General & Internal

Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage

Rita Varudo et al.

Summary: Phosphate disturbances are common in patients with acute spontaneous subarachnoid hemorrhage (sSAH) and may have important implications for neurological outcomes. Patients with sSAH have lower phosphate levels compared to nonneurocritical patients, but require higher daily phosphate replacement. Hypophosphatemia may be associated with poor neurological outcomes in sSAH patients.

CUREUS JOURNAL OF MEDICAL SCIENCE (2021)

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Article Geriatrics & Gerontology

A comparison of two different refeeding protocols and its effect on hand grip strength and refeeding syndrome: a randomized controlled clinical trial

Sissel Urke Olsen et al.

Summary: In this randomized clinical trial of 85 older adults who received two different refeeding protocols, with tight control of electrolytes, no significant difference in hand grip strength was found (p = 0.78). A more assertive refeeding protocol providing 20 kcal/kg/day did not improve hand grip strength or nutritional status at 3 months compared with a cautious refeeding protocol (10 kcal/kg/day), neither did it show a higher incidence of mortality.

EUROPEAN GERIATRIC MEDICINE (2021)

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Article Nutrition & Dietetics

Refeeding risks in patients requiring intravenous nutrition support: Results of a two-centre, prospective, double-blind, randomised controlled trial

Tim Ambrose et al.

Summary: In this study comparing high and low rate feeding in patients requiring nutrition support, there was no evidence of increased refeeding related disturbances in those on high rate feeding compared to low rate. Secondary endpoints including cardiac rhythm analysis, infections, and length of stay did not show differences between the groups.

CLINICAL NUTRITION ESPEN (2021)

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Article Medicine, General & Internal

Refeeding syndrome is associated with increased mortality in malnourished medical inpatients Secondary analysis of a randomized trial

Natalie Friedli et al.

MEDICINE (2020)

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Article Medicine, General & Internal

Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

Janice L. Kwan et al.

BMJ-BRITISH MEDICAL JOURNAL (2020)

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Article Nutrition & Dietetics

The Refeeding Syndrome revisited: you can only diagnose what you know

G. Janssen et al.

EUROPEAN JOURNAL OF CLINICAL NUTRITION (2019)

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Article Medicine, General & Internal

Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial

Philipp Schuetz et al.

LANCET (2019)

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Article Critical Care Medicine

Impact of a computer-assisted decision support system (CDSS) on nutrition management in critically ill hematology patients: the NUTCHOCO study (nutritional care in hematology oncologic patients and critical outcome)

Florence Ettori et al.

ANNALS OF INTENSIVE CARE (2019)

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Review Pathology

Disorders of phosphate metabolism

Jenny Leung et al.

JOURNAL OF CLINICAL PATHOLOGY (2019)

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Article Medicine, General & Internal

Refeeding Syndrome: A Consensus-Based Algorithm for Inpatients

Emilie Aubry et al.

AKTUELLE ERNAHRUNGSMEDIZIN (2019)

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Review Endocrinology & Metabolism

Is refeeding syndrome relevant for critically ill patients?

Wilhelmina A. C. Koekkoek et al.

CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE (2018)

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Article Medicine, General & Internal

Refeeding syndrome. Pathophysiology, risk factors, prevention, and treatment

R. Wirth et al.

INTERNIST (2018)

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Article Nutrition & Dietetics

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

Natalie Friedli et al.

NUTRITION (2018)

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Article Nutrition & Dietetics

Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: A retrospective study

Laura E. Olthof et al.

CLINICAL NUTRITION (2018)

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Review Nutrition & Dietetics

Revisiting the refeeding syndrome: Results of a systematic review

Natalie Friedli et al.

NUTRITION (2017)

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Article Medicine, General & Internal

Adult parenteral nutrition in the North of England: a region-wide audit

Jessica K. Dyson et al.

BMJ OPEN (2017)

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Article Critical Care Medicine

Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial

Gordon S. Doig et al.

LANCET RESPIRATORY MEDICINE (2015)

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Article Anesthesiology

Decision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system

Ulrike Pielmeier et al.

JOURNAL OF CLINICAL MONITORING AND COMPUTING (2012)

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Article Nutrition & Dietetics

Refeeding hypophosphataemia is more common in enteral than parenteral feeding in adult in patients

Sebastian Zeki et al.

CLINICAL NUTRITION (2011)

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Review Nutrition & Dietetics

Refeeding syndrome: Treatment considerations based on collective analysis of literature case reports

Akwasi Afriyie Boateng et al.

NUTRITION (2010)

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Article Critical Care Medicine

Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study

Marie Vignaud et al.

CRITICAL CARE (2010)

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Review Medicine, General & Internal

Refeeding syndrome in cancer patients

M. A. Marinella

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE (2008)

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Review Nutrition & Dietetics

Nutrition in clinical practice - the refeeding syndrome: illustrative cases and guidelines for prevention and treatment

Z. Stanga et al.

EUROPEAN JOURNAL OF CLINICAL NUTRITION (2008)

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Review Medical Laboratory Technology

Hepatic surgery-related hypophosphatemia

Harish K. Datta et al.

CLINICA CHIMICA ACTA (2007)

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Article Medicine, General & Internal

Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival

N Kagansky et al.

JOURNAL OF INTERNAL MEDICINE (2005)

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