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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Having now described the serious sequela that can occur when you initiate nutritional support in a malnourished patient, let us turn to the methods for preventing them. In the descriptions above, we learned that refeeding syndrome can lead to weakness, tetany, ileus, seizures, cardiac arrhythmias, respiratory failure and death. We distinguished between the common forms of refeeding syndrome and its rarer manifestations. The common forms are predominantly an electrolyte-driven disturbance of potassium, phosphate and magnesium balance. The rarer conditions are mostly due to serious thiamine deficiency syndromes including WE, WKS and beriberi. Each patient may present with a slightly different set of signs and symptoms based on the relative ratios of the deficiencies, the organ sites involved and the amount of glucose they are given.
Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
In malnourished patients, providing increased calories without appropriate vitamins and trace elements can precipitate deficiency syndromes (e.g. of potassium, magnesium and phosphate). Refeeding syndrome is potentially fatal and prevented by a slow reintroduction of balanced nutrition and daily monitoring and replacement of micronutrients. Most secondary care Trusts will have an emergency refeeding policy to prevent harm; examples are also widely available online.
Adolescent Medicine
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Perry B. Dinardo, Jennifer Hyland, Ellen S. Rome
Risk factors for refeeding syndrome include patients with chronic malnutrition (including prolonged fasting, oncologic patients), chronic diuretic use, inflammatory bowel disease, significant vomiting or diarrhea, acute weight loss of greater than 10% of body weight in 1–2 months, and patients with underlying complex health needs (Tables 22.3 and 22.4).
Manuscript title: the maxillary swing approach – the first Scandinavian experience
Published in Acta Oto-Laryngologica, 2021
Hani Ibrahim Channir, Magnus Balslev Avnstorp, Irene Wessel, Jørgen Rostgaard, Niclas Rubek, Katalin Kiss, Christian von Buchwald, Jimmy Yu Wai Chan, Birgitte Wittenborg Charabi
Hospitalization rates and postoperative complications are listed in Table 3. The median duration at the intensive care unit postoperatively was 1 day (range: 1 − 3 days) and the median total hospitalization was 13 days (range: 9 − 29 days). Nine patients experienced postoperative complications, of which refeeding syndrome was the most common and diagnosed in four of the patients (#2, #5, #6, #10). Refeeding was anticipated and treated according to local guidelines with no sequelae. One of these patients (#6) required central venous catheter placement due to malfunction of nasogastric tube in order to administer parenteral nutrition. A second (#10) had dysphagia and developed an aspiration pneumonia. Two patients (#14 and #15) experienced severe choanal atresia due to flap shrinkage requiring surgery two months after the maxillary swing procedure. Of the ten patients with reconstruction performed, only one patient (#5) had a minor partly flap necrosis measuring 5 cm which was removed without compromising the complete flap (vastus lateralis free flap). One patient (#4) developed a retromaxillary hematoma which was evacuated under secondary surgery. No serious bleeding was experienced postoperatively. None of the patients developed a carotid blowout.
Refeeding syndrome in hematological cancer patients – current approach
Published in Expert Review of Hematology, 2020
Nicola Szeja, Sebastian Grosicki
In a prospective observational study conducted by Kraaijenbrink et al. [56] of 178 patients included in the study, 54% were considered to be at risk of developing RS, and 8% patients actually developed the syndrome (14% of patients at risk). The most critical moment of RS in the analyzed studies is the first 3 days after the start of nutritional therapy. This is probably due to a change in metabolism from a catabolic to an anabolic state and electrolytes transcellular shifts [48,57]. In the case of highly developed RS, mortality reaches up to 50% [14]. On the other hand, in a retrospective study by Olthof et al. [53], 36.8% of the 337 included patients developed refeeding syndrome. Interestingly, these patients had a reduced 6-month risk of mortality at low calorie intake compared to normal intake.
Kwashiorkor on the south shore
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Samuel T. Arcieri, Szeya Cheung, Alexander Belkin, Ajish Pillai, Ravi Gupta
The mainstay of treatment and prevention of kwashiorkor is initiation of a protein-rich diet [7]. However, these patients are at risk of developing refeeding syndrome when treatments are instituted, which is characterized by metabolic and electrolyte changes. The WHO has developed guidelines and a three-phase management approach for managing severe malnutrition, in which phase 1 involves initial resuscitation and stabilization, phase 2 introduces nutritional rehabilitation, and phase 3 involves follow up for prevention of recurrence [8–10].