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Inicio Medicina Clínica (English Edition) The refeeding syndrome. Importance of phosphorus
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Vol. 150. Issue 12.
Pages 472-478 (June 2018)
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Vol. 150. Issue 12.
Pages 472-478 (June 2018)
Review
DOI: 10.1016/j.medcle.2018.03.018
The refeeding syndrome. Importance of phosphorus
El síndrome de realimentación. Importancia del fósforo
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Marta Araujo Castroa,
Corresponding author
martaazul.2a@hotmail.com

Corresponding author.
, Clotilde Vázquez Martínezb
a Servicio de Endocrinología y Nutrición, Hospital Universitario Rey Juan Carlos, Madrid, Spain
b Servicio de Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Tables (4)
Table 1. Causes of hypophosphataemia, hypokalaemia and hypomagnesaemia.
Table 2. Criteria of the NICE Guidelines to identify patients at risk of refeeding syndrome (Recommendation Level D).
Table 3. Biochemical abnormalities and clinical manifestations of RS.
Table 4. Preventive measures in refeeding syndrome. 2006 NICE Guidelines.
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Abstract

Refeeding syndrome (RS) is a complex disease that occurs when nutritional support is initiated after a period of starvation. The hallmark feature is the hypophosphataemia, however other biochemical abnormalities like hypokalaemia, hypomagnesaemia, thiamine deficiency and disorder of sodium and fluid balance are common.

The incidence of RS is unknown as no universally accepted definition exists, but it is frequently underdiagnosed.

RS is a potentially fatal, but preventable, disorder. The identification of patients at risk is crucial to improve their management.

If RS is diagnosed, there is one guideline (NICE 2006) in place to help its treatment (but it is based on low quality of evidence).

The aims of this review are: highlight the importance of this problem in malnourished patients, discuss the pathophysiology and clinical characteristics, with a final series of recommendations to reduce the risk of the syndrome and facilitate the treatment.

Keywords:
Refeeding syndrome
Hypophosphataemia
Starvation
Hypokalaemia
Hypomagnesaemia
Prevention
Resumen

El síndrome de realimentación es una enfermedad compleja que ocurre cuando se inicia el soporte nutricional después de un periodo de ayuno. La característica principal es la hipofosfatemia, sin embargo, también son comunes otras alteraciones bioquímicas como la hipomagnesemia, el déficit de tiamina y las alteraciones hídrico-electrolíticas.

Su incidencia es desconocida, ya que no existe una definición universalmente aceptada, pero con frecuencia está infradiagnosticado.

El síndrome de realimentación es un trastorno potencialmente fatal pero prevenible. Identificar a los pacientes en riesgo es crucial para mejorar su manejo.

Si se diagnostica existen unas guías (NICE 2006) para orientar su tratamiento (pero basadas en un bajo grado de evidencia).

Los objetivos de esta revisión son: destacar la importancia de este problema en pacientes desnutridos, discutir su fisiopatología y características clínicas y dar una serie de recomendaciones finales para disminuir el riesgo de desarrollarlo y facilitar su tratamiento.

Palabras clave:
Síndrome de realimentación
Hipofosfatemia
Ayuno
Hipopotasemia
Hipomagnesemia
Prevención

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