Refeeding syndrome can occur when a malnourished person starts eating again, causing water retention and decreased levels of electrolytes. This can lead to serious complications, including heart failure and death. Patients should be closely monitored for the condition and started on lower food levels to reduce the risk. Intravenous phosphate concentrations and electrolyte tests can help manage the condition.
Refeeding syndrome is a condition that can occur when a person who has been through prolonged periods of hunger or poor diet starts eating again, which can cause water retention and decreased levels of potassium, magnesium and phosphorus. These symptoms can cause serious physical complications, including heart failure and even death. The condition was first observed during World War II, in prisoners of war.
Patients who have not eaten for long periods of time, or who have been malnourished, should be closely monitored for refeeding syndrome during the first few days after reintroduction of food and other forms of nutrition. The condition typically manifests itself within the first few days of treatment. People being treated for anorexia nervosa and alcoholism are also at risk for the condition.
After long periods of starvation or malnutrition, the body begins to release less insulin because there are fewer carbohydrates to process. The body starts using the fat and protein stored in the body to generate energy and keep the person alive. This use of protein and fat stores reduces the amount of electrolytes in the body’s cells, including phosphate.
When a starving or malnourished person is reintroduced to food or intravenous nutrition, the body begins to metabolize carbohydrates again, for energy. The pancreas secretes more insulin into the body, and phosphate levels can drop dramatically, causing seizures, respiratory failure, coma, or heart failure. Reintroducing carbohydrates also puts a strain on the respiratory system which can be fatal when combined with respiratory problems resulting from phosphate levels.
The stomach begins to deteriorate after long periods of starvation and produces fewer digestive enzymes. Therefore, when food is reintroduced, it can be difficult for the patient to process it. Many patients experience nausea and diarrhea when they begin eating again, and it may take several days or weeks for the stomach to adjust to digesting food again.
Starting a malnourished patient on lower food levels, between 25 and 50 percent of the person’s estimated daily calorie needs, can help reduce the risk of refeeding syndrome. Nutrition professionals in hospitals and clinics can help monitor malnourished patients for signs of the condition before symptoms become fatal, so they can improve with proper treatment.
Patients experiencing refeeding syndrome are typically given intravenous phosphate concentrations for 24 hours. After this initial period, medical professionals closely monitor the patient’s phosphate levels for several days and give more phosphate as needed. Other electrolyte imbalances can also occur, and patients who have refeeding syndrome may have several tests to determine the amount of electrolytes in their bloodstreams to avoid further complications.
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