Refeeding syndrome can develop when someone who is malnourished begins to eat again. The syndrome occurs because of the reintroduction of glucose, or sugar. As the body digests and metabolizes food again, this can cause sudden shifts in the balance of electrolytes and fluids. These shifts can cause severe complications, and the syndrome can be fatal.
It can take as few as 5 successive days of malnourishment for a person to be at risk of refeeding syndrome. The condition can be managed, and if doctors detect warning signs early, they may be able to prevent it.
Symptoms of the syndrome usually become apparent within several days of treatment for malnourishment.
What are the causes of refeeding syndrome?
Refeeding syndrome can occur when food is reintroduced to a person who is malnourished.
If a person does not eat enough, the body can quickly go into starvation mode and become malnourished.
After an extended period of starvation, the ability to process food is severely compromised.
A malnourished body produces less insulin, and this inhibits the production of carbohydrates.
If the body has insufficient carbohydrates, it uses fat reserves and stored proteins for energy.
If, over time, the body continues to rely on reserves of fat and protein, this can change the balance of electrolytes. Levels of vitamin and electrolytes diminish as the body tries to adapt to starvation mode. Potassium, phosphorus, magnesium, calcium, and thiamine levels are commonly affected.
When food is reintroduced, the body no longer has to rely on reserves of fat and protein to produce energy.
However, refeeding involves an abrupt shift in metabolism. This occurs with an increase in glucose, and the body responds by secreting more insulin. This can result in a lack of electrolytes, such as phosphorous.
Refeeding syndrome can cause hypophosphatemia, a condition characterized by a phosphorus deficiency. It can also lead to low levels of other important electrolytes.
If doctors are unable to treat the syndrome, it can be fatal.
Refeeding syndrome can occur after a period of malnourishment, which happens in cases of anorexia nervosa. Learn more about anorexia nervosa here.
Refeeding syndrome affects people who do not receive enough nutrition.
Undergoing particular surgeries, especially weight loss surgeries, can also increase a person's risk.
Electrolytes play an essential role in the body. When the balance is skewed, the most common complication is hypophosphatemia, which is a lack of phosphorus.
Refeeding syndrome can also lead to a lack of magnesium. Hypomagnesemia is the name for dangerously low levels of magnesium.
In some cases, a potassium deficiency can lead to a coma or death.
Doctors can identify people at risk for refeeding syndrome, but it is impossible to know whether a person will develop it. Attempting to prevent the syndrome from developing is vital.
A history of alcohol use disorder can put a person at risk for refeeding syndrome.
People who have experienced recent starvation have the highest risk of developing refeeding syndrome.
The risk is high when a person has an extremely low body mass index.
People who have recently lost weight quickly, or who have had minimal or no food before starting the refeeding process are also at significant risk.
Anyone who suspects that they have refeeding syndrome should seek immediate medical care.
People with refeeding syndrome need to regain normal levels of electrolytes. Doctors can achieve this by replacing electrolytes, usually intravenously.
Replacing vitamins, such as thiamine, can also help to treat certain symptoms. A person will need continued vitamin and electrolyte replacement until levels stabilize.
Doctors may also slow the refeeding process, to help a person to adjust and recover.
The person will require continual observation in a hospital. Doctors will monitor electrolyte levels and bodily functions with tests, including urine and blood analyses.
Recovery times vary, depending on the extent of illness and malnourishment.
Treatment will continue for up to 10 days, and monitoring may continue afterward.
If a person has complications or underlying medical problems, treatment for these may lead to longer recovery time.
It is important for healthcare professionals to look out for warning signs and treat at-risk patients.
Prevention is the most effective way to combat refeeding syndrome.
Healthcare professionals that are aware of warning signs and risk factors are better able to treat malnourished patients.
In 2013, researchers found that in a large sample of people being fed intravenously in the UK, 4 percent had refeeding syndrome. The authors noted that doctors only recognized the risk in half of the at-risk patients.
Surgery and illnesses such as cancer can result in increased metabolic demands, leading to malnourishment.
Malnourishment can also occur when the body no longer absorbs nutrients as it should. This can result from conditions such as celiac disease and inflammatory bowel disease.
Patients at high risk of malnourishment and refeeding syndrome must be identified and treated. Guidelines state that doctors should consider a person's alcohol intake, nutrition, weight changes, and psychological state before refeeding.
Refeeding syndrome can occur when food is reintroduced too quickly after a period of starvation or malnourishment. This can lead to electrolyte imbalances and severe complications that can be fatal.
The best way to combat refeeding syndrome is to identify and treat at-risk people. People with the syndrome can recover if they receive treatment early. Education and increased awareness of the condition can help.
Cadman, Bethany. "What is refeeding?." Medical News Today. MediLexicon, Intl., 13 Jun. 2018. Web.