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Refeeding Syndrome
Lara Heuft1, Jenny Voigt, Lars Selig
1Institut für Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of LeipzigMedical Center, Leipzig, GermanyInstitute for Human Genetics, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Endocrinology, Nephrology, Rheumatology, Division of Endocrinology, University ofLeipzig Medical Center, Leipzig, GermanyDepartment of Endocrinology, Nephrology, Rheumatology, Special Division of Endocrinology,University of Leipzig Medical Center, Leipzig, Germany Klinik und Poliklinik für Endokrinologie,Nephrologie, Rheumatologie, Spezialbereich Ernährungs medizin, Universitätsklinikum LeipzigHelmholtz Institute for Metabolic, Obesity, and Vascular Research (HI-MAG), Helmholtz ZentrumMünchen, University of Leipzig, and the University Hospital Leipzig, Leipzig, GermanyInstitute for Laboratory Medicine, Microbiology, Clinical Pathology, and Pathobiochemistry, UniversityHospital Lippe, Detmold, Germany.
Background:
Refeeding syndrome (RFS) can occur in malnourished patients when normal, enteral, or parenteral feeding is resumed. The syndrome often goes unrecognized and may, in the most severe cases, result in death. The diagnosis of RFS can be crucially facilitated by the use of clinical decision support systems (CDSS).
Methods:
The literature in PubMed was searched for current treatment recommendations, randomized intervention studies, and publications on RFS and CDSS. We also took account of insights gained from the development and implementation of our own CDSS for the diagnosis of RFS.
Results:
The identification of high-risk patients and the recognition of manifest RFS is clinically challenging due to the syndrome's unspecific symptoms and physicians' lack of awareness of the risk of this condition. The literature shows that compared to patients without RFS, malnourished patients with RFS have significantly greater 6-month mortality (odds ratio 1.54, 95% confidence interval: [1.04; 2.28]) and an elevated risk of admission to intensive care (odds ratio 2.71 [1.01; 7.27]). In a prospective testing program, use of our own CDSS led to correct diagnosis in two thirds of cases.
Conclusion:
RFS is difficult to detect and represents a high risk to the patients affected. Appropriate CDSS can identify such patients and ensure proper professional care.
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