Document Detail


Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited.
MedLine Citation:
PMID:  18390784     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Commentary is provided on the pivotal paper by Weinsier and Krumdieck from 1981 describing 2 patients who developed profound and fatal refeeding syndrome following initiation of aggressive total parenteral nutrition. This classic description was among the first to describe the overwhelming cardiovascular and pulmonary manifestations that can accompany parenteral refeeding with carbohydrate in chronically malnourished patients. The syndrome has also been described with oral and enteral nutrition. One of the hallmarks of the syndrome is hypophosphatemia. Since 1981, dosing schemes for addressing hypophosphatemia have been refined. Other manifestations of the syndrome include other electrolyte abnormalities such as hypokalemia and hypomagnesemia, hyperglycemia, fluid and sodium retention, and neurologic and hematologic complications. Case reports of refeeding syndrome continue to be published, particularly in the anorexia nervosa population. Stressed, critically ill patients may be at risk of refeeding following short periods of fasting; hypophosphatemia is commonly encountered in this situation. It behooves the current nutrition support practitioner to keep in mind the types of patients at risk of refeeding syndrome and to approach refeeding of such patients with caution and careful monitoring.
Authors:
Sarah J Miller
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Publication Detail:
Type:  Comment; Journal Article    
Journal Detail:
Title:  Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition     Volume:  23     ISSN:  0884-5336     ISO Abbreviation:  Nutr Clin Pract     Publication Date:    2008 Apr-May
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-08-11     Revised Date:  2010-04-29    
Medline Journal Info:
Nlm Unique ID:  8606733     Medline TA:  Nutr Clin Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  166-71     Citation Subset:  IM; N    
Affiliation:
University of Montana, Department of Pharmacy Practice, Missoula, MT 59812, USA. sarah.miller@umontana.edu
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MeSH Terms
Descriptor/Qualifier:
Enteral Nutrition / adverse effects
Heart Arrest / etiology,  mortality
Humans
Hypophosphatemia / complications,  prevention & control*
Metabolic Diseases / etiology*,  mortality
Nutrition Disorders / complications,  mortality,  therapy*
Parenteral Nutrition / adverse effects*
Phosphates / administration & dosage*,  blood
Chemical
Reg. No./Substance:
0/Phosphates
Comments/Corrections
Comment On:
Am J Clin Nutr. 1981 Mar;34(3):393-9   [PMID:  6782855 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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