nice guidelines refeeding syndrome 2021 nice guidelines refeeding syndrome 2021

official website and that any information you provide is encrypted J Eat Disord 9, 90 (2021). Nutr Clin Pract. Later, diagnostic criteria and algorithms for the RFS diagnosis based on both electrolyte abnormalities and clinical manifestations have been proposed [5,10,11]. Only 44% (8/19) of doctors compared with 70% (49/70) of dietitians followed the guidance. Nevertheless, a bundle of variables could be identified to empirically assess the magnitude of both values. Eur Eating Disord Rev. 2019;8(3):1248. https://doi.org/10.1111/1747-0080.12058. In some cases, refeeding syndrome can be fatal. This definition is somewhat unique in its incorporation of potassium and magnesium changes. Reduce the caloric intake to 20 kCal/hr for at least two days. Phosphate, an electrolyte that helps your cells convert glucose into energy, is often affected. Higher caloric refeeding is safe in hospitalised adolescent patients with restrictive eating disorders. The evolution of all aspects of HPN is presented. RH was found in 37% (10/27). The flowchart relative to the selection process is reported in Fig. https://doi.org/10.1002/ncp.10187. Consequently, poor muscle status, determined by CT imaging, does not justify denying a patient an oncologic resection. The subjects at risk of developing RFS are characterized by reduced insulin secretion and increased glucagon release, with a metabolic shift towards the utilization as energy sources of proteins and fats instead of glucose with resulting muscle mass loss, and a decrease in intracellular vitamins and minerals, particularly phosphate, potassium, and magnesium, due to undernutrition [4]. CR168s Summary of Junior Marsipan: Management of really sick patients under 18 with Anorexia Nervosa. Article Phone: 866.485.6911, 2020 ACUTE Center for Eating Disorders & Severe Malnutrition by Denver Health. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. old, P<0.05 [37] and 20% in early onset AN compared to 0% in adult onset AN P<0.05 [43]). (2014). Effect sizes were expressed as 95% confidence intervals (CIs) and calculated using random-effects models. For patients with the highest risk of refeeding syndrome, starting with 5 kcal/kg/day might even be considered (e.g., for a patient with BMI <14 kg/m2 and no nutritional intake for two weeks). sharing sensitive information, make sure youre on a federal Increasing awareness and using screening programs to identify those at risk of developing refeeding syndrome are the next steps in improving the outlook. Prior to 2017, St Georges Hospitals refeeding guidelines (Figure 2/Figure 3) were not in line with NICE's Nutrition Support for Adults guidelines (CG32). This audit included patients from January November 2017 whereby 51 patients were identified as high risk or extremely high risk and 3 were classed as at risk. The studies were analysed for risk of bias independently by CF, KH and JM. CF performed the discussion. Search strategies combined keywords with controlled vocabulary terms (MeSH, Thesaurus); both quantitative and qualitative research were included. WebIf the patient is considered to be at high risk of refeeding syndrome, the following steps are advised by NICE (2006): Start nutrition support at a maximum of 10 kcal/kg/day, Int J Eat Disord. Glycaemic control (GC) may improve outcomes, though safe and effective control has proven elusive. (2004). Rizzo SM, Douglas JW, Lawrence JC. Leeds and York Partnership NHS Foundation Trust, Mill Lodge, 520 Huntington Rd, York, YO32 9QA, UK, You can also search for this author in NG under restraint was described as causing distress and risk of injury to both staff and YP [48]. JAMA Pediatr; doi: 10.1001/jamapediatrics.2020.3359Investigators from multiple The duration of underfeeding is typically >7-10 days. Thirty-five observational studies were included in the analysis. Background Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Alternative causes of hypophosphatemia are listed here: Thiamine 200-500 mg IV q8hr-q12hr (use higher dose in the context of any mental status changes, which could reflect the possibility of Wernicke encephalopathy). Serum phosphorus was measured on days 1, 3 and 7 post admission. Madden S, Miskovic-Wheatley J, Wallis A, et al. Nurs Stand. You can learn more about how we ensure our content is accurate and current by reading our. JM was responsible for references and editing. https://doi.org/10.1097/00004703-200412000-00005. Results demonstrated that YP receiving PLT had a significantly reduced requirement for NG (P<0.05). There are currently over 700,000 individuals in the UK with an eating disorder (ED) [1]. Refeeding syndrome awareness, prevention, and management. Rocks T, Pelly F, Wilkinson P. Nutritional management of anorexia nervosa in children and adolescent inpatients: the current practice of Australian dietitians. https://doi.org/10.1038/ejcn.2013.244. Results have shown that NG feeding is used commonly in the hospital setting to treat medical instability as a result of severe malnourishment, and in the specialist eating disorders (ED) unit due to failure to meet oral intake. Some described NG feeds as easier than eating as it disguised the amount due to not swallowing; others felt it was a form of punishment for not gaining enough weight. In the circumstances that their BMI is detrimentally low, a nasogastric (NG) tube may be placed from nose to stomach to pass nutrition. All authors assessed bias risk. Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). This site represents our opinions only. Refeeding syndrome results from underfeeding for a period of time, followed by re-initiation of nutritional support (including enteral nutrition, parenteral nutrition, or even IV dextrose). Refeeding is the process of reintroducing food after malnourishment or starvation. Muscle radiation attenuation (MRA) was measured to evaluate muscle quality. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conversely, Akgul and colleagues [36] described a much shorter average time, 2.5days, that YP required NG before transitioning to an oral diet. From hospital unit to intestinal failure center: Twenty years of history, The goldilocks problem: Nutrition and its impact on glycaemic control. https://doi.org/10.1007/s00787-008-0706-8. Similar to the review conducted by Hale and Logomarsino [33] who found RS to be a rare complication, it is reassuring to find that no study in this review reported YP developing RS despite some studies starting on high calorie NG feeding plans [9, 18, 24, 42]. encourage healthy eating and reaching a healthy body weight cover nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self-esteem, and relapse prevention create a personalised treatment plan based on the processes that appear to be maintaining the eating problem Overall, this review found 5 studies [9, 18, 23, 24, 29] reported some incidence of electrolyte disturbance, 2 studies [29, 39] described epistaxis and 1 study [39] described behavioural problems associated with the procedure. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). 2014;68(2):1717. In the absence of carbohydrates, the body turns to stored fats and proteins as sources of energy. 1Southampton University Hospital NHS Trust, Southampton SO16 6YD, 2Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW. STAR GC is most effective when nutrition and insulin are modulated together with timely responsiveness to persistent hyperglycaemia. As such, this might be most accurately termed carbohydrate refeeding syndrome.. 2 studies [21, 47] examined male only cohorts but both were high risk of bias. 2 of these studies [24, 26] for the first 2472h started with continuous NG feeding, using higher than standard calorie protocols, 24003000kcal per day prevented any initial drop in weight. Controlled studies of patients refeeding process with the outcome of length of stay were included. Giovannino Ciccone: Visualization, Writing - Review & Editing, Supervision. Length of stay was reported in studies from medical and MH ward settings, however, the specific package of treatment YP received in each study was different depending on the country of origin. Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. 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(2015). Encephalitis. A brief historical perspective has been added to better illustrate the center's growth and transformation. Similar results were observed for the incidence of RH, which consistently varied across the studies. 2017;22(5):26972. Research on NG feeding in YP has tended to focus on the acute refeeding phase in paediatric or psychiatric wards to reduce the risk of RS [17]. During the acute refeeding phase the need for weight restoration must be balanced against the risk of developing RS. In the UK, three studies described NG use during medical instability after oral intake was refused [27, 28, 40] and one where oral intake was inadequate [31]. Shifts in electrolyte levels can cause serious complications, including seizures, heart failure, and comas. Given that the procedure can be painful [48] for YP and cause complications [29, 39], there is an urgent need for research exploring this wide variation in use of NG feeding to enable future direction and best practice guidance clinicians. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? Youve consumed little to no food, or well below the calories needed to sustain normal processes in the body, for the past 10 or more consecutive days. Research is still needed to determine the best way to treat refeeding syndrome. Changes in these symptoms were not attributed to the rate of weight restoration suggesting a rapid refeeding schedule would not exacerbate psychiatric symptoms. As a library, NLM provides access to scientific literature. Int J Eat Disord. A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. National Collaborating Centre for Mental Health. Conversely the YP in Paccagnella and colleagues [20] research stated NG was helpful, particularly initially when an oral diet was challenging to manage. Agostino and colleagues [23] demonstrated that YP on medical wards having NG feeds had a mean LOS of 33.8days compared to those in the same setting having an oral diet who had a mean of 50.9days, however, the oral diet was lower in calories therefore taking longer for weight recovery and medical stabilisation. The incidence of RFS is at present uncertain due to heterogeneity of subjects involved and the lack of a universally accepted definition [3,4,7]. Start vitamin B12 (cyanocobalamin) 1,000 micrograms orally twice daily. 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. FOIA The National Institute for Clinical Excellence has produced guidance for providing nutrition recommending a graded approach [15]. This could have the advantage of reducing LOS in medically stable YP. Gradual initiation of nutrition for the highest risk patients. A review conducted by Rizzo and colleagues [49] (2019), which focused on NG for acute refeeding, also found a wide variety of practices. Results imply modulation of nutrition alongside insulin improves GC, particularly in patients with persistent hyperglycaemia/low glucose tolerance. Table1 includes a summary of included studies. Medical wards used continuous feeding more frequently than MH wards, however this tended to be for a short period of time while the YP was medically unstable, after this they would be transitioned to an oral diet [22, 23, 25, 26]. Skeletal muscle index (SMI), quantifying muscle mass, was assessed with computed tomography (CT) in 98 patients undergoing esophagectomy. https://doi.org/10.1136/archdischild-2016-310506. It occurs in significantly malnourished patients when a diet of increasing calories is initiated orally, by nasogastric (NG) tube and/or delivered intravenously. A broader view of electrolyte shifts may be a welcome addition, given that prior definitions have focused excessively on phosphate. Thiamine (e.g., 500 mg IV q8hr, if mental status changes). Accessibility PubMed 3729-3740, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. However, refeeding is also a critical component to recovery and NG feeding will often be utilised if a young person has been unable to manage oral intake in order to prevent signs of physical unwellness [9, 10]. Intravenous (IV) infusions based on body weight are often used to replace electrolytes. In most studies the NG feed supplemented any deficit in oral intake but occasionally also provided additional calories above those prescribed in the oral meal plan [22, 25, 39]. This preliminary exploratory study shows that GNG and EGP have different predictors on days 4 and 10; EGP is more correlated with the metabolic level, while GNG is dependent on external factors. Recovering from refeeding syndrome depends on the severity of malnourishment before food was reintroduced. Studies using bolus feeds stated that oral intake was encouraged and it was only when this was not fully achieved that supplementary NG was used [39]. https://doi.org/10.24953/turkjped.2016.06.010. This appeared to be either after each meal, at set times during the day or once in the evening [27]. Our results suggest that a robust model might be built, but requires a prospective study including a larger number of patients. A systematic review of the published literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15]. Certain conditions may increase your risk for this condition, including anorexia, alcohol use disorder, and more. Fabrizio Pasanisi: Visualization, Writing - Review & Editing. 2019;34(3):35970. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. Andrea Evangelista: Formal analysis; Software. Weight loss of more than 10 percent of his or her body weight in the past 3 to 6 months; Little to no food for the past 5 or more consecutive days; or. Inclusion terms were: enteral feeding by nasogastric tube, under 18years, eating disorders, and primary research. Less time spent being underfed may still result in refeeding syndrome if the patient were under, Abuse, neglect, inadequate access to food, Hyperemesis gravidarum or protracted vomiting, Malabsorption (e.g., inflammatory bowel disease, short gut syndrome, s/p bariatric surgery).