Refeeding Syndrome in Malnutrition – Diagnosis and Management

Authors

  • Mei Tsarah Aini Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Klara Yuliarti Nutrition and Metabolic Disease Division, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.3.4.2024.43-59

Keywords:

malnutrition, refeeding syndrome

Abstract

Background: Refeeding Syndrome (RS) is a one of the potentially life-threatening complications in malnourished children. The diagnosis of RS is often challenging due to its diverse clinical manifestations. A comprehensive understanding of the risk factors, sign, symptoms and the management of RS is important to reduce morbidity and mortality.

Discussion: The management of malnutrition consists of a ten-step process divided into three phases. Adherence to this protocol is important to mitigate the risk of RS. RS is a metabolic complication that occurs when malnourished children rapidly reintroduced to nutrition. This condition is characterized by a shift of electrolytes from the extracellular to the intracellular, leading to hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency. Children with RS require aggressive electrolyte and vitamin supplementation, followed by a cautious nutritional re-initiation. A gradual approach to nutritional reintroduction and electrolyte supplementation, are a critical preventive measure of RS.

Conclusion: All malnourished children are at risk of RS. Recognizing its risk factors and watchful monitoring are essential for early detection and prevention of RS.

References

Anato A. Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia. Heliyon. 2022;8(10):e10791. https://doi.org/10.1016/j.heliyon.20 22.e10791 DOI: https://doi.org/10.1016/j.heliyon.2022.e10791

United Nation. SDGS goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture 2024 [Available from: https://sdgs.un. org/goals/goal2.

World Health Organization. The world bank group joint child malnutrition estimates. levels and trends in child malnutrition. Geneva: World Health Organization; 2019.

Kementerian Kesehatan Republik Indonesia. Riset kesehatan dasar tahun 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2019.

Ikobah JM, Uhegbu K, Akpan F, Muoneke L, Ekanem E. Predictors of In-Patient Mortality of Severe Acute Malnutrition of Hospitalised Children in a Tertiary Facility in Southern Nigeria. Cureus. 2022;14(4):e24195. https://doi.org/10.7759/cureus.24195 DOI: https://doi.org/10.7759/cureus.24195

Schwinger C, Golden MH, Grellety E, Roberfroid D, Guesdon B. Severe acute malnutrition and mortality in children in the community: Comparison of indicators in a multi-country pooled analysis. PLoS One. 2019;14(8):e0219745. https://doi.org/10.1371/journal. pone.0219745 DOI: https://doi.org/10.1371/journal.pone.0219745

Corsello A, Trovato CM, Dipasquale V, Bolasco G, Labriola F, Gottrand F, et al. Refeeding Syndrome in pediatric age, an unknown disease: a narrative review. J Pediatr Gastroenterol Nutr. 2023;77(6):e75-e83. https://doi.org/10.1097/mpg.0000000000003945 DOI: https://doi.org/10.1097/MPG.0000000000003945

Hother AL, Girma T, Rytter MJ, Abdissa A, Ritz C, Mølgaard C, et al. Serum phosphate and magnesium in children recovering from severe acute undernutrition in Ethiopia: an observational study. BMC Pediatr. 2016;16(1):178. https://doi.org/10.1186/s12887-016-0712-9 DOI: https://doi.org/10.1186/s12887-016-0712-9

World Health Organization. Guideline updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2013.

Kementerian Kesehatan Republik Indonesia. Buku saku pencegahan dan tata laksana gizi buruk pada balita di layanan rawat jalan. Jakarta: Kementerian Kesehatan RI; 2020.

Tickell KD, Denno DM. Inpatient management of children with severe acute malnutrition: a review of WHO guidelines. Bull World Health Organ. 2016;94(9):642-51. https://doi.org/10.2471/blt.15.162867 DOI: https://doi.org/10.2471/BLT.15.162867

Lenicek Krleza J, Misak Z, Jadresin O, Skaric I. Refeeding syndrome in children with different clinical aetiology. Eur J Clin Nutr. 2013;67(8):883-6. https://doi.org/10.1038 /ejcn.2013.58 DOI: https://doi.org/10.1038/ejcn.2013.58

Blanc S, Vasileva T, Tume LN, Baudin F, Chessel Ford C, Chaparro Jotterand C, Valla FV. Incidence of Refeeding Syndrome in Critically Ill Children With Nutritional Support. Front Pediatr. 2022;10:932290. https://doi.org/ 10.3389/fped.2022.932290 DOI: https://doi.org/10.3389/fped.2022.932290

Okinyi LK, editor The Prevalence of Refeeding Syndrome Among Children with Severe Acute Malnutrition: An Observational Study in Kenyatta National Hospital, Kenya. 2018.

Pantoja F, Fragkos KC, Patel PS, Keane N, Samaan MA, Barnova I, et al. Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre. Clin Nutr. 2019;38(3):1457-63. https://doi.org/10.1016/j.clnu.2018.06.967 DOI: https://doi.org/10.1016/j.clnu.2018.06.967

de Vargas Cony K, de Magalhães Francesconi CF. An unexpectedly high incidence of refeeding syndrome in patients with total parenteral nutrition in a reference university hospital. Clin Nutr. 2021;40(6):3702-7. https://doi.org/10.1016/j.clnu.2021.04.016 DOI: https://doi.org/10.1016/j.clnu.2021.04.016

Hearing SD. Refeeding syndrome. Bmj. 2004;328(7445):908-9. https://doi.org/10.1136/bmj.328. 7445.908 DOI: https://doi.org/10.1136/bmj.328.7445.908

Ormerod C, Farrer K, Harper L, Lal S. Refeeding syndrome: a clinical review. Br J Hosp Med (Lond). 2010;71(12):686-90. https://doi.org/10.12968/hmed.20 10.71.12.686 DOI: https://doi.org/10.12968/hmed.2010.71.12.686

Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. Bmj. 2008;336(7659):1495-8. https://doi.org/10.1136/bmj.a3 01 DOI: https://doi.org/10.1136/bmj.a301

Lenicek Krleza J, Mišak Z, Jadresin O, Grzunov A, Stepan Giljevic J. Refeeding Syndrome in Children: Risk Assessment, Diagnostics and Management. 2014. p. 109-36.

da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020;35(2):178-95. https://doi.org/10.1002/ncp.10474 DOI: https://doi.org/10.1002/ncp.10491

Yoshimatsu S, Chisti MJ, Hossain MI, Islam MM, Fukushima T, Wagatsuma Y, et al. Hypophosphataemia among severely-malnourished children: case series. J Health Popul Nutr. 2012;30(4):491-4. https://doi.org/ 10.3329/jhpn.v30i4.13419 DOI: https://doi.org/10.3329/jhpn.v30i4.13419

Chanchal R, Gupta S, Kanta C, Singh K, Koonwar S. Hypophosphataemia in severe acute malnutrition: a prospective observational study. Br J Nutr. 2019;121(3):306-11. https://doi.org/10.1017/s0007114 518003197 DOI: https://doi.org/10.1017/S0007114518003197

Kimutai D, Maleche-Obimbo E, Kamenwa R, Murila F. Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor. East Afr Med J. 2009;86(7):330-6. https://doi.org/10.4314/eamj.v86i7.54 147 DOI: https://doi.org/10.4314/eamj.v86i7.54147

Namusoke H, Hother AL, Rytter MJ, Kæstel P, Babirekere-Iriso E, Fabiansen C, et al. Changes in plasma phosphate during in-patient treatment of children with severe acute malnutrition: an observational study in Uganda. Am J Clin Nutr. 2016;103(2):551-8. https://doi.org/10.3945/ajcn.115.117374 DOI: https://doi.org/10.3945/ajcn.115.117374

Skipper A. Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. Nutr Clin Pract. 2012;27(1):34-40. https://doi.org/10.1177/ 0884533611427916 DOI: https://doi.org/10.1177/0884533611427916

Birmingham CL, Puddicombe D, Hlynsky J. Hypomagnesemia during refeeding in anorexia nervosa. Eat Weight Disord. 2004;9(3):236-7. https://doi.org/ 10.1007/bf03325074 DOI: https://doi.org/10.1007/BF03325074

Elwagei Suliman Ahmed S, Albougha S, Mahgoub I, Kadori M. Role of Thiamine in Refeeding Syndrome in Children. 2021.

Published

2024-11-30

How to Cite

1.
Refeeding Syndrome in Malnutrition – Diagnosis and Management. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 Nov. 30 [cited 2024 Dec. 4];3(4). Available from: https://apghn.com/index.php/journal/article/view/77