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Refeeding syndrome: relevance for the critically ill patient

Rianne Boot1, Kristine W A C Koekkoek, Arthur R H van Zanten

  • 1Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.

Current Opinion in Critical Care
|June 15, 2018
PubMed

Insights

Refeeding syndrome (RFS) is common in critically ill patients. Monitoring phosphate levels and restricting caloric intake can reduce mortality in RFS patients.

Area of Science:

  • Critical Care Medicine
  • Nutritional Support
  • Intensive Care Unit (ICU) Management

Background:

  • Refeeding syndrome (RFS) is a potentially fatal condition occurring after initiating feeding in starved patients.
  • RFS is characterized by electrolyte imbalances and can lead to cardiac and pulmonary failure.
  • Traditional risk factors for RFS in non-ICU patients are not reliable indicators in critically ill populations.

Purpose of the Study:

  • To review current findings on refeeding syndrome in critically ill patients.
  • To provide evidence-based recommendations for clinical practice regarding RFS management.
  • To highlight the importance of early detection and intervention for RFS.

Main Methods:

  • Literature review of recent studies on refeeding syndrome in critically ill patients.
  • Analysis of diagnostic markers and risk factors for RFS in the ICU setting.
  • Evaluation of treatment strategies, including caloric intake and supplementation.

Main Results:

  • Refeeding syndrome is prevalent in critically ill, ventilated patients.
  • A significant drop in phosphate levels within 72 hours of feeding initiation identifies patients who benefit from caloric restriction.
  • Hypocaloric or restricted caloric intake for at least 48 hours in RFS patients is associated with lower long-term mortality.
  • Standard monitoring of phosphate and electrolyte levels is crucial.

Conclusions:

  • Early identification of RFS using serum phosphate monitoring is essential.
  • Caloric restriction is a key intervention for critically ill patients diagnosed with RFS.
  • Thiamin and electrolyte supplementation are vital components of RFS management.
Abstract

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