Re-nutrition syndrome is a serious problem that can be encountered in patients suffering from anorexia, among others. It occurs when attempts to improve the nutritional status of malnourished people are too intensive, and serious electrolyte disturbances may occur, resulting in cardiac arrhythmias and other disorders. What is the mechanism of re-nutrition syndrome and what can be done to prevent its development?
Table of contents:
- Re-nutrition syndrome - what is it?
- By what mechanism does re-nutrition syndrome develop?
- Re-nutrition syndrome: the problems it can lead to
- Re-nutrition syndrome: what to do if it occurs?
- The re-nutrition syndrome: prevention is paramount
For patients who are struggling with anorexia, the key for many people seems to be to restore their body weight as soon as possible. Indeed, just as compensating for nutritional deficits is one of the primary goals of anorexia treatment, it must be stressed here that this cannot be done too quickly. The well-known saying "the quick is the devil" applies here - Trying to improve the nutritional status of patients suffering from anorexia too quickly can result in them developing a serious problem, which is the re-nutrition syndrome.
Re-nutrition syndrome - what is it?
Refeedingsyndrome ( refeeding syndrome) was first observed in people who left the labour camps after the end of the Second World War. The problem occurred in them after oral nutrition was started. Nowadays, the re-feeding syndrome is observed in slightly different people - the main risk factor for its occurrence is malnutrition. This may be due to an eating disorder (e.g. anorexia), but may also be related to long-term alcoholism or cancer-related wasting. However, malnutrition syndrome can also occur in patients who have undergone bariatric surgery (i.e. surgery to treat obesity) or in patients with malabsorption disorders and inflammatory bowel disease.
By what mechanism does the re-feeding syndrome develop?
When a person is malnourished, his or her body's metabolism is significantly altered. When there is a lack of the basic substance from which we obtain energy, i.e. glucose, the body begins to switch, as it were, to using other sources of energy, such as fats and proteins. When there is a shortage of glucose, the secretion of a hormone that plays an essential role in the management of this sugar - pancreatic insulin - decreases significantly.
When the nutritional treatment of a malnourished patient is undertaken, his or her organism - unaccustomed, as it were, to large supplies of energy substances - is faced with the specific challenge of getting the metabolism back on track. The increased supply of glucose causes a significant increase in insulin secretion by the pancreas. When carbohydrates become the primary source of energy again, phosphates are required for their metabolism - these then begin to be rapidly taken up by cells from the extracellular environment, resulting in a shortage in the blood. This ultimately results in hypophosphataemia, in addition to other electrolyte disturbances such as hypomagnesaemia and hypokalaemia, among others, in the course of refeeding syndrome. With the reintroduction of nutrition, thiamine consumption also increases, so that the patient may also develop thiamine deficiency.
Yet another problem that is associated with the re-feeding syndrome is sodium disturbances. With an increased supply of glucose to the body, there can be a reduction in both sodium and water excretion in the kidneys. These phenomena - especially when fluids are given to the patient - carry the risk of the patient developing oedema.
Re-nutrition syndrome: the problems it can lead to
The electrolyte disturbances that occur in the course of re-nutrition syndrome can have extremely dangerous consequences. They can result in:
- heart rhythm disturbances,
- a feeling of fatigue,
- breathing difficulties,
- convulsions,
- increased blood pressure,
- impaired contractility of the heart muscle, which may even lead to heart failure,
- disturbance of consciousness (even coma).
Usually, the symptoms of re-feeding syndrome appear within the first four days of the patient starting nutritional treatment (the problem can occur with both oral and parenteral nutrition).
Re-nutritionsyndrome, photo: panthermedia
Sometimes, electrolyte disturbances in the course of re-feeding syndrome become so severe that they can even lead to the death of the patient. There is no doubt that the problem is therefore definitely serious - but it is impossible to predict in which malnourished patients this entity will occur.
Some risk factors for its development are known, among which are:
- a body mass index (BMI) below 16,
- weight loss of 15 per cent or more over 3-6 months,
- not eating or eating small amounts of food for the past 10 days,
- low levels of phosphorus, potassium or magnesium in the blood
Re-nutrition syndrome: what to do if it occurs?
Re-nutritionsyndrome first and foremost requires the compensation of electrolyte disturbances that occur in its course. Patients with re-nutrition syndrome are therefore given electrolytes whose levels are found to be too low in their laboratory tests.
In addition, when this entity occurs, a slowdown in nutritional treatment is also required. The problem in this case is that there are no specific guidelines as to how exactly a malnourished patient should be fed in order to prevent the onset of realimentation syndrome. Thus, very different strategies are in fact used, such as one in which the nutritional process is started by feeding the patient significantly less than the calculated energy value (even by as much as half), and the due requirement is reached within 3-5 days. In the case of re-feeding syndrome, sometimes the feeding process is stopped until the patient's abnormalities regarding electrolyte levels have been corrected.
Symptomatic treatment of patients with re-feeding syndrome is sometimes also necessary. This includes the treatment of cardiac arrhythmias and the management of seizures in some patients.
The re-feeding syndrome: prevention is the most important
The consequences of re-feeding syndrome - as mentioned above - can be very serious, after all, the individual may even be life-threatening for the patient. For this reason, trying to prevent its occurrence is so important. To this end, it is necessary to search for possible risk factors for refeeding syndrome before starting nutritional treatment. If such factors are identified, the nutritional therapy must be modified accordingly - attention must be paid, above all, to ensuring that the refeeding process is not too rapid. It is also necessary - before starting nutrition - to perform basic laboratory tests to identify possible electrolyte disturbances.
There are also opinions that the start of nutritional treatment in malnourished patients should be preceded by the administration of a set of various vitamins and micronutrients (above all, the use of vitamin preparations containing vitamin B1, i.e. thiamine, should be considered).