WebThe NICE guideline on eating disorders states that there is no international agreement on admission criteria for in-patient care and that thresholds specified vary. 2016;49(3):293310. The PRISMA flowchart was used (Fig. After removing duplicates, 975 records were screened for titles and abstracts, and then, after excluding articles not meeting the inclusion criteria, 107 full papers were assessed for eligibility and 35 articles met the criteria for the inclusion in the analysis. However, this study does not discuss the reasons NG was implemented. We use cookies to help provide and enhance our service and tailor content and ads. It is evident that there is a wide variety of practices regarding implementation and regime of NG feeding in YP with eating disorders globally [9]. JPEN J Parenter Enteral Nutr. A brief historical perspective has been added to better illustrate the center's growth and transformation. Research on NG feeding in YP has tended to focus on the acute refeeding phase in paediatric or psychiatric wards to reduce the risk of RS [17]. This study sought to (1) determine whether RFS, as operationalized in the 2020 American Society for Parenteral and Enteral Nutrition (ASPEN) guideline definition, is associated with adverse clinical outcomes and (2) identify key risk Over time, this change can deplete electrolyte stores. Two studies examined therapeutic interventions to reduce the need for NG or length of time on it in medically stable YP [29, 41]. Its caused by sudden shifts in the electrolytes that help your body metabolize food. The As a library, NLM provides access to scientific literature. The Refeeding Protocol in Anorexia Nervosa Re-examined WebThe NICE (National Institute for Health and Clinical Excellence) in England has listed criteria for identifying a patient who may be at increased risk for refeeding problems. Overall, these manifestations are variable and insensitive tools for detecting refeeding syndrome. Complications that require immediate intervention can appear suddenly. Further research is warranted to determine whether refeeding syndrome prolongs the length of stay, and to verify the effect of different energy intakes during refeeding on the length of stay in people with malnutrition. 3677-3687, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Maginot TR, Kumar MM, Shiels J, Kaya W, Rhee KE. In patients experiencing refeeding syndrome, a dangerous shift in fluids and electrolytes occurs within the body, resulting in compromised cardiovascular status, respiratory failure, seizures and even death. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence=44%; 95% CI 36%52%) and RH (pooled incidence=27%; 95% CI 21%34%). Some studies have demonstrated that the bioavailability of oral thiamine is substantial. This appeared to be either after each meal, at set times during the day or once in the evening [27]. Guidelines help identify patients at elevated risk for developing this life-threatening complication of reintroducing calories in the early stages of anorexia nervosa treatment. Cut back rate of nutrition (e.g., 25-50% of usual caloric target, depending on severity). The risk for developing refeeding syndrome correlates directly with the extent of weight loss that accompanies anorexia nervosa. Background. Meal support therapy reduces the use of nasogastric feeding for adolescents hospitalized with anorexia nervosa. Last medically reviewed on January 6, 2020. Nutr Clin Pract. Nutritional rehabilitation is central to achieving medical stabilization. https://doi.org/10.7748/ns.2017.e10509. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Strik Lievers L, Curt F, Wallier J, Perdereau F, Rein Z, Jeammet P, et al. We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM. Source: Garber AK, Cheng J, Accurso EC, et al. Its caused by sudden shifts in the electrolytes that help your When individuals who are at risk are identified early, treatments are likely to succeed. WebRefeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study Any discussion on the risks of the refeeding syndrome should include the increased threat of infection that may often be silent in malnutrition. Preventative therapies: Thiamine 100-200 mg q12-24. It seems logical to avoid administering insulin if possible (e.g., allowing glucose to rise to ~200-300 mg/dL). Bias can also occur due to the different treatment groups being recorded at different times thus confounding variables may include different staff working at the setting and therefore different methods of treating YP. (2015). The majority commenced on daily intake of less than 2000kcal and increased periodically. Therefore, the present systematic review and meta-analyses aimed to estimate the incidence of RFS in adults by considering the definition used by the authors as well as the recent criteria proposed by the ASPEN consensus (when applicable). Kristen Hindley. PubMed Robb et al [39] compared nocturnal NG feeding to supplement oral diet (maximum 3255 kcals /d) with oral intake (max 2508 kcals/d) reporting nocturnal NG feeding weight gain of 5.4kgs versus 2.4kgs in the oral diet only group. 2017;5(1):110. 58% of the studies included only examined the effect of NG feeding as a secondary outcome of their study. Marianna Pellegrini: Data curation, Writing - Review & Editing. Learn the difference between these two conditions. Structured, supported feeding admissions for restrictive eating disorders on paediatric wards. Monitor electrolytes carefully. Perhaps carbohydrates should initially be limited to <40% of the total energy intake. People who are at risk of heart-related complications may require heart monitoring. (2001). 2019;34(3):35970. Int J Eat Disord. The incidence of refeeding syndrome is difficult to determine, as there isnt a standard definition. Nutr Clin Pract. American Psychiatric Association. Paccagnella A, Mauri A, Baruffi C, Berto R, Zago R, Marcon ML, et al. Similarly, the incidence of RH ranged between 7% and 62%. The site is secure. https://doi.org/10.1002/erv.2614. Other factors can also put you at an increased risk of developing refeeding syndrome. Recovering from refeeding syndrome depends on the severity of malnourishment before food was reintroduced. Rhabdomyolysis can occur (causing an elevated creatinine kinase). Thiamine (e.g., 500 mg IV q8hr, if mental status changes). Phone: 866.485.6911, 2020 ACUTE Center for Eating Disorders & Severe Malnutrition by Denver Health. This is unknown. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI). Until a consensus definition is obtained, the following criteria seems reasonable: (29901461). However, if the analysis was adjusted for confounders, e.g., Charlson Comorbidity Index, no relevant association regarding long-term survival was detected. An essential first step in acute treatment is nutritional rehabilitation (refeeding malnourished patients) and restoring a healthy body weight. HHS Vulnerability Disclosure, Help Madden et al [22] RCT determined the duration of NG feeding was a minimum of 14days, using biochemical markers of medical instability in a hospital setting. 2005;38(2):1436. (2016). This difference could account for the divergent outcomes from studies on the impact NG has on the LOS between medical and psychiatric settings [23, 44]. Conversely, Akgul and colleagues [36] described a much shorter average time, 2.5days, that YP required NG before transitioning to an oral diet. Nasogastric (NG) feeding use in YP with ED may be used as a lifesaving treatment when patients are physically unwell [7, 8]. The flowchart relative to the selection process is reported in Fig. In 2006, the National Institute for Health and Clinical Excellence (NICE) published a risk-assessment tool for the definition of the RFS risk [9]. Anorexia Nervosa in the Acute Hospitalization Setting Length of stay was reported in studies from medical and MH ward settings, however, the specific package of treatment YP received in each study was different depending on the country of origin. ASPEN Consensus Recommendations for Refeeding Syndrome Nutr Clin Pract. Int J Eat Disord. (NICE Guideline, No. NG was also implemented due to acute refusal of food or inability to meet oral intake, without significant medical instability, in five studies [9, 10, 18, 31, 43]. PubMed 1Southampton University Hospital NHS Trust, Southampton SO16 6YD, 2Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW. Patients with RH underwent further evaluation for RFS-associated findings. CR168s Summary of Junior Marsipan: Management of really sick patients under 18 with Anorexia Nervosa. Differences may be due to variable expertise of staff. Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). 8600 Rockville Pike In this cross-sectional study, we analyzed plasma SCFA levels, HIF3A expression, and CpG methylation of HIF3A intron 1 in peripheral blood from patients with type 2 diabetes presenting with (n=92) and without (n=105) cardiomyopathy. These studies discussed ceasing NG feeds after the risk of RS had reduced; most gave a time frame between 2 and 14days [24, 44]. Overall, this review found 5 studies [9, 18, 23, 24, 29] reported some incidence of electrolyte disturbance, 2 studies [29, 39] described epistaxis and 1 study [39] described behavioural problems associated with the procedure. Guidance Algorithm for prevention and management of refeeding 2 studies [21, 47] examined male only cohorts but both were high risk of bias. Consequently, poor muscle status, determined by CT imaging, does not justify denying a patient an oncologic resection. Aggressive repletion of electrolytes, with the exception of calcium (IV calcium may exacerbate hypophosphatemia). 3729-3740, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Hypophosphatemia during critical illness has been associated with adverse outcome. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. 2022, Journal of Parenteral and Enteral Nutrition, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. NICE clinical guideline 32 (2006) criteria for recognising patients 1. specialist registrar gastroenterology and clinical nutrition. 2009;190(8):4104. Refeeding syndrome: Is a less conservative approach to refeeding safe? NOTE: Fabio Bioletto: Data curation, Writing - Review & Editing. WebThese consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. For this reason, acute medical intervention is often warranted in order to reduce mortality. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. guidelines Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. Three studies were qualitative interview studies, examining patient or staff feelings towards NG feeding in practice which increases the risk of confirmation bias. 167 (prepared by the Duke University evidence-based practice center under contract no. 2002;159(8):134753. statement and A Systematic Review of the Role of Thiamine https://doi.org/10.1080/10640260902991236. The National Institute for Clinical Excellence has produced guidance for providing nutrition recommending a graded approach [15]. From this systematic review 3 methods of NG feeding in YP with ED were found: continuous [23, 25], nocturnal [26, 29], and bolus meal replacement [9]. 2016;58(6):6419. Bayes A, Madden S. Early onset eating disorders in male adolescents: a series of 10 inpatients. The outcomes of interest were: Opinions of YP and staff using NG, amount of YP requiring NG, any interventions that impacted on NG feeding, complications of NG feeding, interventions to mitigate the complications, the setting (medical ward, psychiatric ward or outpatient), the NG method and whether this changed when restraint was required. Skrik Liever et al [44] reported 27% required NG feeding and linked this to a faster weight gain but gave no information related to NG feeding protocols. Young people with eating disorders often restrict food intake to a degree which is detrimental to their physical health. A broader view of electrolyte shifts may be a welcome addition, given that prior definitions have focused excessively on phosphate. DOI: Hearing SD. These include: Refeeding syndrome can cause sudden and fatal complications. In the UK, three studies described NG use during medical instability after oral intake was refused [27, 28, 40] and one where oral intake was inadequate [31]. Refeeding Syndrome Guideline systematic review of enteral feeding by nasogastric Refeeding Syndrome The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe Springer Nature. KH and CF performed search of databases and created the document. Early RFH occurred in 40 patients (3%) in total, significantly more in the early-PN group (n=31, within-group occurrence 5%) than in the late-PN-group (n=9, within-group occurrence 1%, p<0.001). Interestingly, butyric acid levels positively correlated with HIF3A levels, while a negative association was identified between butyric acid levels and the methylation rates of HIF3A intron 1at CpG 6. Start vitamin B12 (cyanocobalamin) 1,000 micrograms orally twice daily. Permissive hyperglycemia could be safer than the administration of high doses of insulin. The incidence of RFS is at present uncertain due to heterogeneity of subjects involved and the lack of a universally accepted definition [3,4,7]. Titles and abstracts were screened by all authors before reviewing full length articles. (2011). All rights reserved. https://doi.org/10.1002/eat.1040. You have a history of alcohol use disorder or use of certain medications, such as insulin, chemotherapy drugs, diuretics, or antacids. Identifying the associations between plasma SCFA levels and intronic DNA methylation of HIF3A may reveal useful predictors or provide insights into the disease processes of DCM. Weight loss of more than 15 percent of his or her body weight in the past 3 to 6 months; Little to no food for the past 10 or more consecutive days; or. There was a wide variety in length of time receiving NG for medical instability. 777 Bannock Street Similar to the review conducted by Hale and Logomarsino [33] who found RS to be a rare complication, it is reassuring to find that no study in this review reported YP developing RS despite some studies starting on high calorie NG feeding plans [9, 18, 24, 42]. California Privacy Statement, Syndrome A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders. Wernicke encephalopathy (ocular abnormalities, ataxia, delirium), Weakness (including respiratory muscle weakness). 08-E012. Nutr Clin Prac. Refeeding protocols daily calorie intake varied greatly between studies particularly as many studies were evaluating the outcome of higher calorie refeeding protocols [9, 18, 22, 24, 31]. Furthermore, the incidence of refeeding hypophosphatemia (RH) was also assessed. Refeeding Syndrome: Definition, Treatment, Risks, and More Studies published in languages other than English were translated prior to being reviewed. Attitudes to NICE guidance on refeeding syndrome We therefore advocate septic screening and a low threshold for broad spectrum antibiotic cover for any patients with unexplained hypothermia, hypoglycaemia, and evidence of malnutrition. Different methods of NG may be utilised safely, with NG feeds often given as large bolus, continuously through a pump or overnight in order to supplement daytime oral intake [12, 13]. Normalization of weight can reverse nearly all of the general medical sequelae of the underweight state, with the exception of bone health [ 3-5 ]. Routine NG feeding may allow greater initial caloric intake, which does not increase risk of medical complications, and may actually increase initial weight gain thus reducing time in hospital. Patients who were older (OR 1.14 (95% CI 1.08; 1.21) per year added, p<0.001) and who had a higher Pediatric Risk of Mortality (PIM3) score had a higher risk of developing early RFH (OR 1.36 (95% CI 1.15; 1.59) per unit added, p<0.001), whereas patients in the late-PN group had a lower risk of early RFH (OR 0.24 (95% CI 0.10; 0.49), p<0.001). PubMed Central NG feeding involves a fine bore tube passed via the nasal passage into the stomach in order to administer nutrition.
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