Refeeding syndrome

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The term refeeding syndrome is a group of sometimes life-threatening symptoms that can be caused by the rapid intake of normal amounts of food after a long period of malnutrition.

Medical history

In the 1st century AD, the Roman-Jewish historian Flavius ​​Josephus documented the starvation of Jewish prisoners in Roman captivity. Some of the prisoners were able to escape the Roman occupation forces. When they returned to freedom, they overdone and died a short time later. The historian described that it was mainly those who died that filled their stomachs. But those who restrained their appetite escaped death.

This phenomenon was first described in more detail medically during the liberation of Japanese prisoners of war and the liberation of National Socialist concentration camps in World War II . However, it also plays an important role today, for example in the treatment of anorexia nervosa .

Pathophysiology

Due to the insufficient supply of the organism with glucose , the most important energy source, the body begins in times of malnutrition to meet most of its energy needs by burning fat ( lipolysis ). This is associated with an increase in free fatty acids in the blood, but also a decrease in glucose and insulin concentrations.

If the organism suddenly has enough glucose again after this change, it reacts by stopping lipolysis and increasing the release of insulin in order to transport the glucose in the blood into the cells. This is also associated with an increase in the intracellular potassium , magnesium and phosphate concentrations with a corresponding decrease in the concentrations outside the cells (and in the blood). Due to the resulting imbalance in the intra- and extracellular electrolyte concentrations, the symptoms described arise.

Symptoms

The clinical symptoms of refeeding syndrome usually manifest themselves within the first four days of resumption of a normal diet. The classic signs are water retention in the tissue ( edema ), acute heart failure and an acute vitamin B-1 deficiency. Due to the fact that the different electrolyte concentrations intra- and extracellularly are required in particular to maintain the resting potential of the nerve cells, neurological failure symptoms often occur. Additional signs may include by hypomagnesemia induced arrhythmia , ataxia be, convulsions and tremors. Hypokalaemia can cause arterial hypotension , cardiac arrest, constipation ( constipation ), and respiratory failure. A breakdown of red blood cells ( hemolysis ), platelet and leukocyte dysfunction can occur as further symptoms.

Prophylaxis and treatment

Due to the fact that unnoticed refeeding syndrome usually leads to death, in addition to avoiding refeeding syndrome through gradual and not sudden physiological food intake (an initial diet of approx. 15 kcal per kg body weight / d, with up to For metabolic stabilization of the patient, the supply of food energy should only be increased slowly in the first ten days), a close control of the electrolytes in the blood is also required. Missing electrolytes should be substituted .

literature

  • C. Zauner, N. Kneidinger, G. Lindner, B. Schneeweiß, A. Zauner: The refeeding syndrome. In: Journal for Gastroenterological and Hepatological Diseases. 4, 2005, pp. 7-11 ( full text online, pdf ).
  • S. Rohrer, JW Dietrich: The Refeeding Syndrome - A literature review. [Refeeding Syndrome: A Review of the Literature.] In: Z Gastroenterol. 2014 Jun; 52 (6), pp. 593–600. Epub 2014 Jun 6. PMID 24905111 doi: 10.1055 / s-0034-1366430

Web links

Individual evidence

  1. ↑ Li Doa, Peter E. Ballmera, Maya Rühlina: The Complexity of the Refeeding Syndrome. Swiss medical forum - Swiss Medical Forum (2017) 17 (24): 524 medicalforum.ch
  2. ↑ JP Knochel: Phosphorus. In: Maurice E. Shils, Moshe Shike, A. Catharine Ross, Benjamin Caballero, Robert J. Cousins: Modern Nutrition in Health and Disease. Tenth Edition. Lippincott Williams & Wilkins, Philadelphia 2006, ISBN 978-0-7817-4133-0 , pp. 211-221.
  3. ↑ Li Doa, Peter E. Ballmera, Maya Rühlina: The Complexity of the Refeeding Syndrome. Swiss medical forum - Swiss Medical Forum (2017) 17 (24): 523–528 medicalforum.ch
  4. ↑ M. Korbonits, D. Blaine, M. Elia, J. Powell Tuck: Metabolic an hormonal changes during the refeeding period of prolonged fasting. In: Eur J Endocrin. 157, 2007, pp. 157-166.