Refeeding syndrome in malnutrition by jaime rizzie on prezi. Ppt refeeding syndrome powerpoint presentation, free. Insulin concentrations decrease while glucagon increases during starvation. If youre ever in for major surgery, its the reason they slowly work you up to solid foods over time, rather than just letting you eat normally. Refeeding syndrome is a metabolic disturbance that occurs as a result of reinstitution of nutrition to people who are starved, severely malnourished or metabolically stressed due to severe illness. Jun 26, 2008 refeeding syndrome is a well described but often forgotten condition. Nov 02, 1985 full text full text is available as a scanned copy of the original print version. Chronic malnourishment can occur with severe parasitism, malabsorptive or maldigestive disorders, neglect, animal abuse, starvation, etc. Get a printable copy pdf file of the complete article 236k, or click on a page image below to browse page by page.
Apr 15, 2004 is underdiagnosed and undertreated, but treatable refeeding syndrome was first described in far east prisoners of war after the second world war. Resomal available commercially can also be made by diluting one packet of the standard whorecommended ors in 2 litres of water. Prevention and treatment of refeeding syndrome in the. Refeeding syndrome is associated with increased mortality. Risk factors of refeeding syndrome in malnourished older. Normally, glucose is the bodys preferred fuel, coming from the intake of carbohydrates. Prevention and treatment of refeeding syndrome in the acute. However, refeeding previously starved, malnourished patients must be done with the utmost. Refeeding syndrome has been observed in adults who have had long periods of starvation eg, anorexia nervosa and malabsorptive syndromes with an incidence rate of 10% 12.
The refeeding syndrome is an uncommon multisystem disorder which may occur when feeding is reintroduced following a period of starvation. Incidence of refeeding syndrome and its associated factors in. In this study, we sought to compare the prevalence and severity of malnutrition among older hospitalized patients with prevalence of known risk factors of rfs. Refeeding syndrome was first described in the 1940s. You only find what you look for, and you only look for what you know. Out of them, 17 million were affected by the most severe and life threatening form of wasting. The net result of metabolic and hormonal changes in early starvation is that the body switches from using carbohydrate to using fat and protein as the main source of energy, and the basal.
This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of. Jan 26, 2009 refeeding syndrome is an important, yet commonly overlooked condition affecting patients. A final diagnosis of chronic alcoholic malnutrition with refeeding syndrome was made. Incidence commonly in toddlers between the age years, following or with weaning kwashiorkor edematous malnutrition. Fluid and glucose shifts are also important to monitor if refeeding syndrome is suspected. Refeeding syndrome is a constellation of fluid and electrolyte dysregulation that occurs upon initiation of enteral or parenteral nutrition following a period of malnutrition or starvation. Starvation and refeeding syndrome powerpoint ppt presentation. Refeeding syndrome is a series of metabolic events precipitated by the provision. Refeeding syndrome can develop in patients who are chronically malnourished for any reason. Malnutrition is a condition that results from eating a diet in which one or more nutrients are either not enough or are too much such that the diet causes health problems. L tachypnea and tachycardia may be useful early clinical signs of refeeding syndrome developing in a patient who has been renourished after a period of starvation. Starvation for more than a few days reduces the overall stores of phosphorus, magnesium and potassium and induces a reduction in the secretion of insulin. Magnesium is required for more than 300 enzyme pathways. Overview of refeeding syndrome starvation understanding the physiology of starvation pro.
The key to the pathophysiology is the stimulation of insulin release resulting in anabolic activity. Thiamine deficiency in selfinduced refeeding syndrome, an. Ppt refeeding syndrome powerpoint presentation free to. The irish society for clinical nutrition and metabolism irspen is a multidis. Review article the importance of the refeeding syndrome. At the end stage of wasting, however, physical activity dramatically decreases as well as energy intake. Ppt starvation and refeeding syndrome powerpoint presentation. Nutrition implications of starvation and refeeding syndrome presentation transcript. It may involve calories, protein, carbohydrates, vitamins or minerals. Starvation and the refeeding syndrome food for thought.
During periods of starvation, the liver transitions to gluconeogenesis, when fat and subsequently proteins. More often, the spectrum of presentation ranges from simple nausea. In 2012 acute malnutrition was present in 51 million children, 8% of children under 5. In humans, prolonged starvation can cause permanent organ damage and eventually, death. Perspectives of the dietitian, psychotherapist and medical physician. Crude estimates of incidence, morbidity, and mortality are available for specific populations. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition.
An awareness of the condition and a high index of suspicion are required in order to make the diagnosis. These are the sickest of sick people, but still was found rarely. Refeeding syndrome an overview sciencedirect topics. Refeeding syndrome awareness, prevention and management. The possible deleterious effects of feeding after a period of prolonged starvation have been known for over 60 years. Jul 19, 2017 3, 4 proteinenergy malnutrition pem, first described in the 1920s, is observed most frequently in developing countries but has been described with increasing frequency in hospitalized and chronically ill children in the united states. Implications of refeeding syndrome in postoperative total. Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organisms life. Refeeding syndrome can occur when food is reintroduced too quickly after a period of starvation or malnourishment.
Refeeding is the process of reintroducing food after malnourishment or starvation. Ppt malnutrition, starvation and refeeding syndrome powerpoint. Mar 25, 2015 the impact of severe malnutrition and medical instability in adolescent anorexia nervosa an on immediate health and longterm development underscores the need for safe and efficient methods of refeeding. So you can see that one of the key prerequisites for refeeding syndrome is severe, prolonged malnutrition. Circumstances, descriptive characteristics, and pathologic findings in dogs suspected of starving. Acuity of symptoms in chronically and acutely malnourished patients were analyzed to determine the influence the duration of malnutrition has on refeeding syndrome. Mehler 1, 2, 3, 1 eating recovery center 7351 e lowry blvd, suite 200, denver, co 80230. From malnutrition to refeeding during anorexia nervosa. In 2006 a guideline was published by the national institute for health and clinical excellence nice in england and wales. Severe fluid and electrolyte shifts and related metabolic complications in malnourished patients undergoing refeeding. Refeeding syndrome is associated with increased mortality in. Its diagnosis is frequently missed resulting in severe complications and even death. Malnutrition, starvation and refeeding syndrome powerpoint. May 31, 2012 refeeding syndrome metabolic disturbances occur at this point starvation loss of lean muscle mass, water and minerals phosphorus carbohydrate refeeding, insulin release glucose uptake hyphosphatemia red cell atp k,mg, glucose,thiamine 11.
Refeeding syndrome can be fatal if not recognized and treated properly. We describe the management of a 4yearold child with acute lymphoblastic leukaemia all who presented with febrile neutropenia, cryptosporidium and subsequently developed refeeding syndrome. Alerts and notices synopsis refeeding syndrome is a medical complication following a prolonged period of malnutrition or starvation, when rapid intake of food and fluids creates electrolyte imbalances that can result in multiorgan dysfunction and can be fatal. Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely. Despite the high prevalence of malnutrition among older hospitalized persons, it is unknown how many of these malnourished patients are at risk of developing the refeeding syndrome rfs. Nutrition implications of starvation and refeeding syndrome ppt. Renal function may also affect both the presentation. Refeeding syndrome in malnutrition agenda ancel keys and the minnesota experiment malnutrition defining malnutrition what is refeeding syndrome. Malnutrition, starvation and refeeding syndrome khursheed jeejeebhoy refeeding syndrome am j clin nutr 1979. Rfs has been recognised in the literature for over fifty years and can result in serious harm and death. The refeeding syndrome can be defined as the metabolic alterations developed by the rapid nutrition repletion oral, enteral as well as parenteral feeding of severaly malnourished patients. In todays vetgirl online veterinary ce video, we discuss refeeding syndrome, which is a condition that can occur after chronic malnourishment. The refeeding syndrome is a potentially fatal condition that affects multiple organ systems.
Case scenario ram a 18 month old boy was brought to hospital with co poor weight gain. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. This study demonstrates the potential for more rapid. This study shows that even hypocaloric feeding should be considered a susceptibility factor for the refeeding syndrome.
Clinicians need to be aware of it and assume most malnourished patients are at risk. Refeeding hypophosphatemia in adolescents with anorexia. Incidence of refeeding syndrome and its associated factors. This study is a comparison of eating disorder patient outcomes on similar nutrition regimens regardless of degree of malnutrition. Refeeding hypophosphatemia rh is the most common complication associated with refeeding the malnourished patient. Find powerpoint presentations and slides using the power of, find free presentations research about refeeding syndrome ppt. However, consensus guidelines now address malnutrition irrespective of etiology. On rare occasions, refeeding syndrome can complicate the nutritional recovery of children with severe malnutrition, typically within the first days or week of refeeding. Clinical effects of starvation resting energy expenditure fall by about 2535% by 3. Aug 15, 2007 the refeeding syndrome is a potentially lethal complication of refeeding in patients who are severely malnourished from whatever cause. Nutritional refeeding syndrome kwashiorkar and marasmus indore pedicon 2014 1.
It occurs when feeding is commenced after a period of starvation. Malnutrition, starvation and refeeding syndrome malnutrition, starvation and refeeding syndrome khursheed jeejeebhoy refeeding syndrome am j clin nutr 1979. The resultant biochemical disturbance, symptoms, and signs have been termed the refeeding syndrome rs. Nutritional refeeding syndrome kwashiorkar and marasmus. Refeeding syndrome in verylowbirthweight intrauterine. Lessons learned with rs, primarily magnesium and potassium. It is the consequence of fluid and electrolyte shifts that may occur in a malnourished patient. The underlying causative factor of refeeding syndrome is the metabolic and hormonal changes caused by rapid refeeding, whether enteral or parenteral.
Jan 06, 2020 refeeding is the process of reintroducing food after malnourishment or starvation. Hypomagnesemia is defined as serum mg resting energy expenditure fall by about 2535% by 3. Starvation may also be used as a means of torture or execution. Current refeeding guidelines in an advocate low initial caloric intake with slow increases in energy intake to avoid refeeding syndrome. Ppt refeeding syndrome powerpoint presentation, free download. The reintroduction of nutrition to a starved or fasted individual results in a rapid. The pathophysiology of refeeding syndrome has now been established. Refeeding syndrome is a real issue when you go from eating almost nothing to eating a whole lot at once. How to recognize and respond to refeeding syndrome. Starvation use of stored carbohydrate, fat, and protein to meet energy demands liver glycogen fatty acid stores gluconeogenesis glucose needed for. L refeeding syndrome can occur when nutrition in the form of carbohydrate enteral or parenteral is reintroduced following starvation. The risk of developing refeeding syndrome may be related to the degree of prior malnutrition, although it has been reported to occur in critically ill patients after a brief period of starvation. Emphasis was placed by these authors on the hypophosphatemia reported nadirs of 0. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake.
Refeeding syndrome is a well described but often forgotten condition. Risk factors any or all npoclear fluids 710 days chronic etoh useabuse 10% wt loss over past 6 mths physical signs of malnourishment refeeding syndrome the metabolic and physiologic processes that occur as a consequence of depletion during starvation and repletion during refeeding. Febrile neutropenia is common and can be lifethreatening and we highlight the identification of well lowrisk neutropenic children with resolved febrile illnesses suitable for early discharge. When too much food or liquid nutrition supplement is eaten during the initial four to seven days, this triggers the production of glycogen, fat and protein in cells, to the detriment of serum blood. This can occur with both enteral and parenteral nutrition and usually happens within the first 2 weeks of nutritional replenishment. Define refeeding syndrome and list three minerals that should be closely monitored during recovery from starvation or proteinenergy malnutrition and explain why they need to be closely monitored. This was first described during wwii and has since been well documented in human medicine. Bps story practice guidelines current research icd9 code 263. A study of over 10,000 hospitalized patients only found an incidence of 0. Ppt malnutrition, starvation and refeeding syndrome. Refeeding syndrome metabolic disturbances occur at this point starvation loss of lean muscle mass, water and minerals phosphorus carbohydrate refeeding, insulin release glucose uptake hyphosphatemia red cell atp k,mg, glucose,thiamine. Malnutrition, starvation and refeeding syndrome is the property of its rightful owner.
Rapid restoration of nutrients and electrolytes after prolonged starvation could result in a life threatening condition characterized by sensory and neurological dysfunction and severe metabolic imbalance that has been designated as refeeding syndrome. Refeeding syndrome describes the adverse clinical and biochemical problems that may result from feeding malnourished patients via any route, be it oral, enteral or parenteral. Acute malnutrition is the complement, and intimately associated to chronic malnutrition. Acute starvation and refeeding in the present study were defined as 7 d without and with food, respectively. This metabolic adaptation of semi starvation is impaired during refeeding with an increase in the thermic effect of food and a high risk of refeeding syndrome with severe hypophosphatemia.
One of the primary reasons for this lack of agreement is the inherent difficulty in studying patients with refeeding syndrome. It may be rapidly fatal due to cardiorespiratory failure. Refeeding syndrome was first described in far east prisoners of war after the second world war. The net result of metabolic and hormonal changes in early starvation is that the. Explain the pathophysiology of starvation refeeding syndrome and their effects on the body identify factors contributing to the signs and symptoms of starvation refeeding syndrome slideshow 671492 by ananda. Ppt malnutrition, starvation and refeeding syndrome powerpoint presentation free to view id. Refeeding syndrome rfs describes the biochemical changes, clinical. Department of gastroenterology, staffordshire general hospital, weston road, stafford. In 1981, weinsier and krumdieck4 published a paper that outlined dramatic and rapidly evolving refeeding syndrome in 2 chronically malnourished patients who received aggressive dextrosebased tpn.
The true incidence of refeeding syndrome in children with sam is unknown as there is a paucity of studies in this population. Circumstances, descriptive characteristics, and pathologic findings in dogs suspected of starving show all authors. Nutrition in clinical practicethe refeeding syndrome. The refeeding syndrome is a potentially lethal complication of refeeding in patients who are severely malnourished from whatever cause. Refeeding syndrome is a potentially fatal clinical condition and it is often underdiagnosed on nonspecialized nutrition units. Refeeding syndrome is a series of metabolic complications linked to artificial nutritional support in patients who are severely malnourished, with conditions such as kwashiorkor, chronic malnutrition, or anorexia nervosa. Outcomes of a rapid refeeding protocol in adolescent anorexia.
Too rapid refeeding, particularly with carbohydrate may. The clinical presentation may vary from mild forms with few clinical signs and symptoms to severe forms with possible lethal complications. If so, share your ppt presentation slides online with. Malnutrition, starvation and refeeding syndrome ppt. Cachexia, malnutrition, the refeeding syndrome, and. Sep 12, 2010 in 1981, weinsier and krumdieck4 published a paper that outlined dramatic and rapidly evolving refeeding syndrome in 2 chronically malnourished patients who received aggressive dextrosebased tpn. Febrile neutropenia and refeeding syndrome adc education. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. View and download powerpoint presentations on refeeding syndrome ppt. Refeeding syndrome in children in developing countries who. Nutritional recovery refeeding syndromekwashiorkar and marasmus dr rajesh kulkarni pune 2. The electrolyte disturbances of the refeeding syndrome can occur within the first few days of refeeding. We describe a 25yearsold female patient with mental.
Refeeding syndrome rfs is a metabolic condition characterized by severe electrolyte and fluid shifts in response to the transition from a catabolic to an anabolic state after start of nutritional therapy in malnourished patients. The term inanition refers to the symptoms and effects of starvation. Refeeding syndrome rfs describes the biochemical changes, clinical manifestations, and complications that can occur as a consequence of feeding a malnourished catabolic individual. Circumstances, descriptive characteristics, and pathologic.
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