Refeeding syndrome is a type of condition which occurs when a severely starved or malnourished person is fed enthusiastically. This creates a metabolic disturbance in the body. During the starvation period, the body gets adopted to the burning of fats and proteins in order to get energy.
However, when refeeding is started, the body shifts to burn carbohydrates which can cause dramatic disturbances in the level of vital minerals such as potassium, phosphorus, magnesium and calcium. There is associated electrolyte imbalance leading to water and sodium retention in the body.
When overlooked, refeeding syndrome can become potentially fatal problem leading to heart failure, convulsion, coma and death.In the beginning, there is hypophophataemia (meaning low level of phosphate). RFS was recognized during the end of World War II. The malnourished and starved prisoners of war who were released suffered from this syndrome when they were fed.
Signs And Symptoms Of Refeeding Syndrome
Refeeding syndrome is caused as a result of rapid re-institution of feeding in a person who is starved and malnourished which may lead to hypophosphataemia, imbalance of electrolyte, and metabolic complications.
There may be gastrointestinal complications, such as diarrhea, vomiting, abdominal pain, bloating etc. There is low level of potassium, phosphorus, and calcium noted.Due to water and sodium retention there is swelling in feet, hands and face.
Heart failure is a cardiac complication often noted when refeeding syndrome is overlooked. Muscle cramps, weakness, fatigue, vertigo, hallucination, depression are symptoms that may occur as a result of low level of magnesium, phosphate and calcium.
Other grave symptoms may include convulsion, low blood pressure, delirium, arrhythmia, coma and death. There may be associated vitamin deficiency, especially B vitamin thiamine. This may cause neurological problems, confusion etc.
Refeeding Syndrome Nutritional Management
Nutritional management in Refeeding syndrome plays an important and crucial part as early detection can save the patient from complications. Those patients at greater risk are:
- Person who has not taken any food or liquid since last 10 days.
- Person who has lost 15 to 20% of his weight in last 3 months.
- Low levels of potassium, magnesium and phosphate before the refeeding process has been started.
History of alcohol abuse or drug abuse is also important nutritional management criteria for refeeding. Assessing the facts, the physician or the dietician may advise conservative administration of carbohydrates, so that the patient’s body gradually gets adapted to the carbohydrates.
During this period the electrolytes, as well as calcium, potassium, magnesium are closely monitored and also supplemented as per the requirement.
Treatment Of Refeeding Syndrome Symptoms
Since refeeding syndrome can become fatal consequence which is preventable, its recognition and awareness among medical fraternity as well as general public is very much important. It occurs more in people who have lost their weight very fast.
Refeeding syndrome symptoms may occur during the initial days of feeding after starvation. Therefore during this period various levels of vital minerals and vitamins as well as electrolytes should be monitored. Milk is natural refeeding choice as it contains phosphates and it is easily tolerated. Other minerals when found low have to be supplemented.
Oral or parenteral use of vitamin B complex is useful. During the first 3 to 5 days the patient should take 50% of the normal requirement of energy intake.