Group of Medical Students from Westminster Hospital who Worked at Belsen After its Liberation by the Allies
Kieran Walsh in Medical Education, 2016
Belsen concentration camp was liberated by the allies in 1945 and soon afterwards medical students from the United Kingdom came to work there to help the many thousands of ill and starving inmates. Initial attempts to help inmates of concentration camps often went wrong. Prisoners were fed too much too quickly – this caused the ‘refeeding syndrome’ – and many died as a result of biochemical electrolyte disturbances caused by their rescuers’ well-meaning efforts. However, army medics learned from their initial mistakes, and education, on how best to care for people with severe malnutrition quickly spread amongst allied armies.
Medical management
Rachel Bryant-Waugh, Claire Higgins in Avoidant Restrictive Food Intake Disorder in Childhood and Adolescence, 2020
In this chapter the importance of collaborating and co-working with the multi-disciplinary team is stressed, as well as agreement on priorities, with pragmatism around necessary medical interventions. The management of common medical issues seen in ARFID is discussed, including constipation, micronutrient deficiency, growth delay, and low bone density. Where acute medical instability or chronic effects upon growth are identified, weight restoration should be a priority, with clear explanations for the family. The role of medications in ARFID is explored, with a summary of recent evidence for their efficacy and safety. The chapter also explores the risk for re-feeding syndrome in ARFID and how clinicians can work effectively to identify it.
Eating Disorders (EDs)
Maggie L Dwiggins in Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Weight is not the only marker for eating disorders (EDs) — many with EDs can look healthy but be extremely ill: 66% of individuals with EDs are normal weight at onset of disorder, and 33% of individuals with EDs are obese at onset of their ED. Adolescent patients with EDs who are sexually active need contraception and cannot rely on menstrual cycle to predict ovulation. Long-acting reversible contraceptives remain the most reliable contraceptive method and should be considered. Refeeding syndrome is a life-threatening situation of congestive heart failure, liver congestion with elevated liver enzymes, and peripheral edema as a result of total body phosphorus depletion during catabolic starvation followed by increased cellular influx of phosphorus during anabolic refeeding. Validates families' and clinicians' concerns: parents or caregivers are the frontline help-seekers for youth with EDs. Fertility is preserved in individuals who recover from an ED.
Refeeding syndrome in hematological cancer patients – current approach
Published in Expert Review of Hematology, 2020
Nicola Szeja, Sebastian Grosicki
Introduction: According to estimates based on the GLOBOCAN database of the International Agency for Research on Cancer, in 2018 alone, 18 100 000 cancers were globally diagnosed. Importantly, the majority of cancer patients experience unintended weight loss that leads to many adverse clinical consequences, including malnutrition and cancer cachexia. At the same time, each nutritional intervention must be carried out individually, as it can lead to critical complications, resulting in a threat to the health and life of the cachectic patient. An example of this type of risk is refeeding syndrome. Areas covered: Three factors seem to be crucial in this case: early identification of patients at risk of malnutrition, the introduction of an individualized diet regimen and constant monitoring of nutritional intervention. It seems equally important to spread awareness about the possibility of refeeding syndrome and knowledge about its patomechanisms and consequences among medical staff. This should lead to minimizing the risk of refeeding syndrome. Expert opinion: It should be noted that current guidelines on the pathogenesis, risk factors and methods of prevention and treatment of refeeding syndrome require further modifications, that would harmonize the management regimen in both prevention and therapy of refeeding syndrome.
Incidence and Risk Factors of Refeeding Syndrome in Head and Neck Cancer Patients—An Observational Study
Published in Nutrition and Cancer, 2016
Stine Ostenfeldt Rasmussen, Marianne Boll Kristensen, Irene Wessel, Jens Rikardt Andersen
This study aimed to determine the incidence rates of refeeding phenomena (defined as a decline in p-phosphate) and refeeding syndrome (RFS; defined as development of clinical symptoms in addition to a decline in p-phosphate) in head and neck cancer patients, and to identify risk factors. Fifty-four head and neck cancer patients referred for surgery were included. Forty-six potential risk factors were registered at the baseline, and p-phosphate was measured at Days 2, 4, and 7. Eleven patients (20%) developed RFS, and twenty-eight (52%) developed refeeding phenomena. At baseline, these patients presented a higher prevalence of head and neck pain, eating difficulties, higher p-phosphate levels, lower p-transferrin levels, and, in men, lower b-hemoglobin levels. Patients who developed symptoms had a decline in p-phosphate ≥0.22 mmol/l. At baseline, these patients had higher p-phosphate levels, higher alcohol consumption, and lower p-transferrin and p-sodium levels, as well as a higher prevalence of eating difficulties, low handgrip strength (HGS), and a history of radiation therapy. The risk factors most strongly associated with the development of refeeding phenomena and RFS were pain, eating difficulties, low HGS, high alcohol intake, and previous radiation therapy.
Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report
Published in Upsala Journal of Medical Sciences, 2013
Daniel Espes, Joakim Engström, Henrik Reinius, Per-Ola Carlsson
We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome.
Related Knowledge Centers
- Cardiac Arrhythmias
- Glucose Intolerance
- Malnutrition
- Syndrome
- Diarrhea
- Electrolyte Imbalance
- Water