Keep synonym3/13/2023 ![]() ![]() This results in an increase in blood levels of ketone bodies, stimulating the brain to switch from glucose to ketone bodies as its main energy source. Muscle and other tissues decrease their use of ketone bodies and use fatty acids as the main energy source. 13ĭuring prolonged fasting, hormonal and metabolic changes are aimed at preventing protein and muscle breakdown. ![]() 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 metabolic rate decreases by as much as 20-25%. The underlying causative factor of refeeding syndrome is the metabolic and hormonal changes caused by rapid refeeding, whether enteral or parenteral. ![]() 11 12 However, it is often not recognised or maybe inappropriately treated, especially on general wards. 10 Many case reports have highlighted the potentially fatal nature of the condition. 6 9 In a well designed prospective cohort study of a heterogeneous group of patients in intensive care units, 34% of patients experienced hypophosphataemia soon after feeding was started (mean (standard deviation) 1.9 (1.1) days). Several prospective and retrospective cohort studies of hyperalimentation in intensive care units have documented the occurrence of refeeding syndrome. When solutions containing phosphate are used, the incidence can decrease to 18%. 7 Studies report a 100% incidence of hypophosphataemia in patients receiving total parenteral nutrition solutions that do not contain phosphorus. In a study of 10 197 hospitalised patients the incidence of severe hypophosphataemia was 0.43%, with malnutrition being one of the strongest risk factors. The true incidence of refeeding syndrome is unknown-partly owing to the lack of a universally accepted definition. 3 These recommendations differ in parts from-and we believe improve on-previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1). 2 Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion. This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. Refeeding syndrome is a well described but often forgotten condition. ![]()
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