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Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

N. Friedli, Z. Stanga, A. Culkin, M. Crook, A. Laviano, L. Sobotka, RW. Kressig, J. Kondrup, B. Mueller, P. Schuetz,

. 2018 ; 47 (-) : 13-20. [pub] 20170925

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc19045554
E-zdroje Online Plný text

NLK ProQuest Central od 2003-01-01 do Před 2 měsíci
Nursing & Allied Health Database (ProQuest) od 2003-01-01 do Před 2 měsíci
Health & Medicine (ProQuest) od 2003-01-01 do Před 2 měsíci
Health Management Database (ProQuest) od 2003-01-01 do Před 2 měsíci
Public Health Database (ProQuest) od 2003-01-01 do Před 2 měsíci

Odkazy

PubMed 29429529
DOI 10.1016/j.nut.2017.09.007
Knihovny.cz E-zdroje

OBJECTIVES: Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. METHODS: Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. RESULTS: Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. CONCLUSION: Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations.

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$a Stanga, Zeno $u Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital and University of Bern, Bern, Switzerland.
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$a Crook, Martin $u Department of Clinical Biochemistry, Lewisham Hospital NHS Trust, London, United Kingdom.
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$a Laviano, Alessandro $u Department of Clinical Medicine, Sapienza University, Rome, Italy.
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