Refeeding Syndrome

Christian D. Pulcini; Stacey Zettle; Arvind Srinath

doi:10.1542/pir.2015-0152

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Christian D. Pulcini, MD, MEd, MPH*
Stacey Zettle, MS, RD, LDN^†
Arvind Srinath, MD^‡

^*Department of Pediatrics,
^†Department of Clinical Nutrition, and
^‡Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA.

AUTHOR DISCLOSURE
Drs Pulcini and Srinath and Ms Zettle have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Practice Gap

Refeeding syndrome can have potentially devastating metabolic consequences. It is important for the clinician to identify at-risk populations and to evaluate, recognize, and effectively manage this condition.

Objectives

After completing this article, readers should be able to:

Define refeeding syndrome.
Analyze patient scenarios for refeeding syndrome risk factors.
Evaluate the patient at risk for refeeding syndrome.
Interpret refeeding syndrome sequelae.
Manage the patient with refeeding syndrome.

Case Examples

Case #1: A 3-month-old infant is directly admitted to the hospital by his pediatrician for failure to thrive.
Case #2: A 16-year-old girl with anorexia nervosa fails outpatient treatment and is referred for emergency department evaluation. Five months ago, the patient’s body mass index (BMI) was 18 and Z-score was -1.05, indicating mild malnutrition. Her current BMI is 14 and Z-score is -3.95, indicating severe malnutrition. (1)
Case #3: A 9-year-old boy with multiple medical problems who is tracheostomy- and gastrostomy tube-dependent is referred to the hospital because of a 9-lb weight loss in the last 2 months.

Introduction

Refeeding syndrome was first described in the 1940s. (2) However, there is little consensus on the evaluation and management of this condition, particularly in children. One of the primary reasons for this lack of agreement is the inherent difficulty in studying patients with refeeding syndrome. In the 1940s, the Minnesota Starvation Experiment prospectively examined the effects of prolonged starvation in adults via a randomized, controlled trial, but this remains one of the few experiments of its kind examining this condition. (3) The reason for the dearth of research is likely due to the highly morbid complications of refeeding syndrome and …