People who have experienced malnutrition need to receive additional nutrients during recovery. However, direct feeding with large quantities can trigger refeeding syndrome.
Instead of returning to a healthy weight, excessive food intake can actually be life-threatening.
What Is Refeeding Syndrome?
Refeeding syndrome is a condition that occurs due to sudden changes in the body's metabolism and electrolyte balance disorders.
Refeeding is the process of introducing food after a person experiences malnutrition, hunger, or long-term fasting.
The process of introducing food is usually carried out on children who have experienced severe malnutrition or people with eating disorders who are undergoing treatment.
Refeeding should be done with caution because of the high risk of causing refeeding syndrome.
Rapid changes in metabolism cause the body's mineral levels to become unbalanced and the function of the organs of the body will also be affected.
How Does Refeeding Syndrome Occur?
During a nutritional deficiency, your body does not get enough carbohydrates.
Without carbohydrates, blood sugar levels are low. This reduces the production of the hormone insulin, which regulates blood sugar levels.
In addition, your body also loses its main source of energy. The body that used to burn carbohydrates is now burning fat and protein. This process also affects the body's mineral balance.
When there is a lack of nutrients, the levels of the mineral phosphate become unbalanced. In fact, the body's cells need phosphate to convert carbohydrates into energy.
When energy production switches to burning fat and protein, phosphate is no longer used so the amount decreases.
Once the body gets food intake back, there is a drastic change in metabolism. Your body begins to get carbohydrates again as a source of energy.
Energy production that previously came from fat and protein will return to carbohydrates. Blood sugar levels begin to rise, so does the amount of the hormone insulin.
The body's cells then return to looking for phosphate to convert carbohydrates into energy. However, the amount of phosphate in the body is already low, so the body has difficulty burning carbohydrates into energy.
Low levels of phosphate also affect the balance of other minerals, namely sodium and potassium. This condition is also known as electrolyte balance disorder which eventually causes refeeding syndrome.
What Are The Symptoms Of Refeeding Syndrome?
Once there is an electrolyte imbalance due to the refeeding process that is too fast, the body can experience several disorders.
Symptoms of refeeding syndrome that appear can vary, depending on the reduced amount of certain minerals.
- Nerve and muscle problems, seizures, confusion, and loss of muscle mass due to low phosphate levels.
- Lethargy, weakness, nausea, vomiting, and irregular heartbeat due to too little magnesium
- Lethargy, weakness, frequent urination, heart problems, and intestinal obstruction due to low potassium levels.
- Other symptoms include high blood sugar, fluid buildup in the legs, muscle weakness, and mental problems.
What Are The Risk Factors For Refeeding Syndrome?
There are clear risk factors for refeeding syndrome. You may be at risk if you have one or more of the health conditions below.
- Body mass index (BMI) below 16.
- Unexpected weight loss of more than 15% in the past 3–6 months.
- Lack of or not getting nutritional intake for more than 10 days.
You also have risk factors for refeeding syndrome if you have two or more of the following health conditions.
- BMI less than 18.5.
- Sudden weight loss of more than 10% over a period of 3–6 months.
- Get little or no nutritional intake for more than 5 days.
- History of alcohol and drug abuse.
How To Deal With Refeeding Syndrome?
The National Institute for Health and Clinical Excellence (NICE) has established guidelines for treating people with refeeding syndrome in the following ways.
- Check the levels of potassium, calcium, phosphate, and magnesium.
- Get intake of vitamin B1 by mouth of 200-300 mg per day.
- Take a high dose of B multivitamin 1-2 tablets three times a day or a full dose of B vitamins by infusion, and take a multivitamin supplement once a day.
- Get intake and supplements of phosphate, calcium, and magnesium slowly by mouth or intravenously.
- Monitor levels of potassium, phosphate, calcium, and magnesium for the first 2 weeks and adjust the dose of nutrient and fluid intake according to the patient's condition.
What Are The Complications Of People With Refeeding Syndrome?
Citing a study published in Nutrition Issues in Gastroenterology, disturbances in body fluids in patients are at risk of causing complications such as the following.
- Dehydration or risk of excess fluid in the body.
- Cardiovascular disorders, such as arrhythmias, low blood pressure, congestive heart failure, cardiomyopathy, and heart failure.
- Breathing problems, including respiratory failure, weakened diaphragm muscles, difficulty using a ventilator.
- Musculoskeletal disorders, such as rhabdomyolysis, muscle aches, cramps, and weakness.
- Nerve problems, including confusion or delirium, Wernicke's encephalopathy, ataxia, and tetany.
- Blood disorders, namely anemia, thrombocytopenia, reduced oxygen to body tissues.
- Acute kidney failure.
- Metabolic acidosis.
Refeeding syndrome is a complication that must be considered in reintroduction or refeeding.
Despite the good intentions of the patient's recovery, the introduction of food in the wrong way can be harmful to his health.
Remember, every patient has a different body condition and nutritional needs. Therefore, consult a doctor or nutritionist to determine the appropriate food introduction program.
Source: https://hellosehat.com/nutrisi/fakta-gizi/apa-itu-refeeding-syndrome/
