Food Coma: Hyperammonemic Encephalopathy From Refeeding Syndrome

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

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Gastric Band Slippage: Beware of the Refeeding Syndrome After the Band Removal—Comment on “Should We Introduce a Gastric Band Removal Schedule?”

Obesity Surgery ◽

10.1007/s11695-021-05685-3 ◽

2021 ◽

Author(s):

Clemence Boutron ◽

Sylvie Breton ◽

Margot Denis ◽

Adriana Torcivia ◽

Jean-Christophe Vaillant ◽

...

Keyword(s):

Gastric Band ◽

Refeeding Syndrome ◽

Band Slippage ◽

Band Removal

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Low serum phosphate is not diagnostic for refeeding syndrome in critical care

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a282 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

N Venugopal ◽

P Turner ◽

R Kolamunnage-Dono ◽

C Downey ◽

ID Welters

Keyword(s):

Critical Care ◽

Serum Phosphate ◽

Refeeding Syndrome ◽

Low Serum

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Malnutrition in Inflammatory Bowel Diseases. What do we know today?

Kompass Nutrition & Dietetics ◽

10.1159/000516279 ◽

2021 ◽

pp. 1-3

Author(s):

Christina N. Katsagoni

Keyword(s):

Disease Control ◽

Inflammatory Bowel Diseases ◽

Bone Development ◽

Treatment Modalities ◽

Growth Delay ◽

Refeeding Syndrome ◽

Exclusive Enteral Nutrition ◽

Pubertal Delay ◽

Bowel Diseases ◽

Inflammatory Bowel

Growth delay with height and weight impairment is a common feature of pediatric inflammatory bowel diseases (PIBD). Up to 2/3 of Crohn Disease patients have impaired weight at diagnosis, and up to 1/3 have impaired height. Ulcerative colitis usually manifests earlier with less impaired growth, though patients can be affected. Ultimately, growth delay, if not corrected, can reduce final adult height. Weight loss, reduced bone mass, and pubertal delay are also concerns associated with growth delay in newly diagnosed PIBD patients. The mechanisms for growth delay in IBD are multifactorial and include reduced nutrient intake, poor absorption, increased fecal losses, as well as direct effects from inflammation and treatment modalities. Management of growth delay requires optimal disease control. Exclusive enteral nutrition (EEN), biologic therapy, and corticosteroids are the primary induction strategies used in PIBD, and both EEN and biologics positively impact growth and bone development. Beyond adequate disease control, growth delay and pubertal delay require a multidisciplinary approach, dependent on diligent monitoring and identification, nutritional rehabilitation, and involvement of endocrinology and psychiatry services as needed. Pitfalls that clinicians may encounter when managing growth delay include refeeding syndrome, obesity (even in the setting of malnutrition), and restrictive diets. Although treatment of PIBD has improved substantially in the last several decades with the era of biologic therapies and EEN, there is still much to be learned about growth delay in PIBD in order to improve outcomes.

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