The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review
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IM - REVIEW
The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review Valentina Ponzo1 · Marianna Pellegrini1 · Iolanda Cioffi2 · Luca Scaglione3 · Simona Bo1 Received: 29 July 2020 / Accepted: 30 September 2020 © The Author(s) 2020
Abstract The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2–5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome. Keywords Hypophosphatemia · Hypokalemia · Hypomagnesemia · Malnutrition · Refeeding syndrome · Thiamine
Introduction Malnutrition is a frequent and often unrecognized condition among inpatients [1, 2]. Indeed, 20–50% of individuals are at risk of malnutrition or already malnourished at hospital admission, but malnutrition is diagnosed in 7% only [3]. Older age, low socioeconomic status, lack of organizational support, chronic systemic or psychiatric diseases, polytherapy, poor diet, reduced absorption capacity, excessive nutrient losses are the most frequent conditions underlying malnutrition [4]. The management of malnourished inpatients can be difficult due to the risk of metabolic impairment after Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02525-7) contains supplementary material, which is available to authorized users. * Simona Bo [email protected] 1
Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126 Turin, Italy
2
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
3
Internal Medicine Unit, Città della Salute e della Scienza Hospital of Torino, Turin, Italy
the start of nutrition [5]. The adverse outcomes of refeeding were firstly reported during the World War II in rapidly re-fed prisoners who had starved for five to six months [6]. People who have fasted for a long time, developed heart, and/or respiratory failure, peripheral edema, neurological symptoms, and death after the introduction of excessive or even appropriate calorie amount [6–8]. In the 80 s, the term ‘refeeding syndrome’ (RFS) was introduced to describe severe hypopho
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