Refeeding syndrome - さくらのレンタルサーバ

1 Clinical ques4on 2014 2 3 JHOSPITALIST Network Refeeding syndrome .. 163cm, 28kg,BMI , BP109/75mmHg, HR71bpm, SpO2 97%, , , BUN5mg/dl,AST 31IU/. L, ALT17IU/L, , Na 137mEq/L, , 86mg/dl Clinical ques4on Refeeding syndrome . Refeeding syndrome . Refeeding syndrome P Refeeding syndrome : what it is, and how to prevent and treat it BMJ 2008;336:1495- 8 Refeeding syndrome Refeeding ( ) Refeeding . K . Mg P.. B1 .. 1 Refeeding . h\ Enteral Nutrition Group of the ion (box 1).4. ome? Patient at risk Check potassium, calcium, phosphate, magnesium an be defined as the potentially NICE etc electrolytes that may occur in Before feeding starts, administer thiamine 200-300 mg receiving artificial Refeeding daily orally, vitamin B high potency 1-2 tablets 3 times daily (or full dose intravenous vitamin B), and multivitamin arenterally5).

2 These shifts result tabolic changes and may cause or trace element supplement once daily ations. The hallmark biochem- Start feeding MJ/kg/day*. syndrome is hypophosphatae- Slowly increase feeding over 4-7 days is complex and may also rome m and fluid balance; changes in Rehydrate carefully and supplement and/or correct levels of potassium (give 2-4 mmol/kg/day), phosphate at metabolism; thiamine defi- 16. ( mmol/kg/day), calcium, and magnesium and hypomagnesaemia. ( mmol/kg/day intravenously or mmol/kg/day orally).

3 Ng syndrome ? Monitor potassium, phosphate, calcium, and magnesium for the first 2 weeks and amend treatment as appropriate feeding syndrome is unknown ack of a universally accepted *If patient is severely malnourished (for example, body mass index (kg/m2). <14) or if intake is negligible for >2 weeks, start feeding at maximum of 10 197 hospitalised patients the MJ/kg/day pophosphataemia was , Refeeding syndrome : what it is, and how to prevent and treat it ng one of the strongest risk BMJ 2008;336:1495- 8 Guidelines for management.

4 Adapted from the guidelines of ! P Hypophosphatemia K Hypokalemia Ca Hypocalcaemia Mg Hypomagnesaemia ( ) Preven4on and Treatment of Refeeding syndrome in the Acute Care Sebng IrSPEN GUIDELINE DOCUMENT P (hallmark) O'Connor and Nicholls 36. (%mBMI ) The majority of subjects' baseline serum phosphate levels were within normal ranges prior to Refeeding (1 mmol/L). P Post- Refeeding serum phosphate levels were obtained within 48 hours of commencing Refeeding and ranged from mmol/L. The mean post- Refeeding phosphate levels in the ( R.)

5 Chart/observational 2 =. reviews and case , and mmol/L, respectively. Most authors in this review = .01 ) mmol/L. deemed an episode of hypophosphatemia below mmol/L, which is the lower serum reference range for adolescents. Of the 1039 adolescents identified in the chart/observational stud- ies, 131 developed RH (< mmol/L). The incidence of RH in the chart/observational reviews ranged from 0% 38%, with an average incidence of 14%. The chart/observational studies report an average initial Refeeding intake of 1500 kcal/d (38 kcal/kg), ranging from 1200 1900 kcal/d (30 48 kcal/kg).

6 Most articles increased calorie intake by 200 300 kcal/d until estimated requirements 22,34,35. for weight gain were met. Three of the 7 studies used the method by Moore et al to calculate % ideal body weight 36. (IBW). The other 4 studies used weight for age, height, and sex Figure 1. Relationship between malnutrition (% median body 48 P ( ) 14%. as % mBMI (percentage median body mass index for age-and- sex) 14,19,26. or using the National Center for Health Statistics mass index [mBMI]) and post- Refeeding serum phosphate level (mmol/L), with data from chart reviews and case reports.

7 20.. growth charts, which ranged from 81% with a weighted mean of ( 1039 ). The chart reviews that recorded Pearson correlation between the sum of % mBMI on admission 2. and sum of post- Refeeding serum phosphate R linear = weight ranged from 41 kg, with a mean of kg. (P = .01). The case reports had an average initial Refeeding intake of Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systema4c review. 972 kcal/d (31 kcal/kg), ranging from 125 1700 kcal/d (5 65. Nutr Ckcal/kg). lin Pract. The 2013 % JmBMI.

8 Un;28(3):358- 64. was calculated Epub for2all 013 theMcase ar 4. reports at the lower end of normal, which further decreased onc on admission weight and ranged from 50% 70% (mean of 59% Refeeding was initiated at around 1500 kcal/d. The other stud ATP 2,3- GDP Preven4on and Treatment of Refeeding syndrome in the Acute Care Sebng IrSPEN GUIDELINE DOCUMENT Wernicke Korsako 2,3- DPG Preven4on and Treatment of Refeeding syndrome in the Acute Care Sebng IrSPEN GUIDELINE DOCUMENT Refeeding syndrome . Wernicke Korsako.)

9 Na .. Refeeding syndrome : what it is, and how to prevent and treat it BMJ 2008;336:1495- 8 Uptodate Refeeding syn. Vol. 110 Hearing SD. Refeeding syndrome . BMJ 2004;328:908- 9. Na4onal Ins4tute for Health and Clinical Excellence. Nutri4on support in adults. Clinical guideline CG32. A pocket guide to clinical nutri4on. 2nd ed. Bri4sh Diete4c Associa4on, 2001. NICE 1 BMI kg/m2 BMI kg/m2 (level D recommenda4ons) NICE 10kcal/kg/day BMI<14 or 15 5kal/kg/day 4~7 ( 5kcal/kg/day ) B1 200- 300mg/day O'Connor and Nicholls 359.

10 1. Recommended Refeeding Guidelines for Malnourished as the Table Refeeding syndrome , a physiological phenomenon that Patients With Anorexia Nervosa. occurs while Refeeding the undernourished patient, a process driven by ,18,31 RH is the most consistently reported Guidelines Age kcal/kg biochemical disturbance seen in the Refeeding This review sought to gauge the range of Refeeding rates Australia and New Zealand: Adult 15 20 (600 800 kcal/d) Refeeding syn.. Beumont et al48 adopted globally and the implication that total energy intake Europe: Stanga et al46 Adult 10 15 and malnutrition may have on RH while Refeeding malnour- United Kingdom: Royal Adult 10 20 ished.