Refeeding syndrome – pathobiochemistry, electrolyte dysbalances and their correction
Authors:
A. Kazda 1; H. Brodská 1; F. Novák 2; S. Ševela 2
Authors‘ workplace:
Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN v Praze
1; IV. interní klinika, 1. LF UK a VFN v Praze
2
Published in:
Klin. Biochem. Metab., 22 (43), 2014, No. 4, p. 169-176
Overview
During long lasting starvation the insufficient supply of energy is compensated from own sources of organism. The store of glycogen is soon exhausted and the production of insulin decreases. During initial period the main source of energy used is all body protein. Later on lipids are preferred. However to some extent the lean body mass is always depleted. This depletion is accompanied by decreased intracellular pool of phosphates, potassium and magnesium. Thanks to gradual release from catabolic cells during malnutrition, their plasma levels remain in reference ranges for long time. The depletion affects also the important metabolic factors, such as the trace elements and vitamins, thiamine especially.
During realimentation sugars become the main source of energy again and catabolism of fat and protein is interrupted. The restored secretion of insulin and start of anabolism turn the shift of the afore mentioned ions back into the cells. Their plasma levels as well as the levels of thiamine may extremely fall in short time. As consequence of these changes the refeeding syndrome (RS) may develop. The severe multiorgan dysfunction may develop including the cardiac failure. The paper presents the proceedings recommended for the malnutrition risk screening and also for the detection of risk of RS. The possible diverse clinical manifestations of this syndrome are presented. The article follows the description of clinical and laboratory monitoring at the start of realimentation in severely malnourished high risk patients. When RS is already diagnosed, the described corrections of ion dysbalances are sometimes aggressive, according to their plasma levels.
Key words:
malnutrition, refeeding syndrome, hypophosphatemia, hypokalemia, hypomagnesemia.
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Clinical biochemistry Nuclear medicine Nutritive therapistArticle was published in
Clinical Biochemistry and Metabolism
2014 Issue 4
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