The Experts below are selected from a list of 882 Experts worldwide ranked by ideXlab platform
Mark A Marinella - One of the best experts on this subject based on the ideXlab platform.
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Refeeding Syndrome in cancer patients
2016Co-Authors: Mark A MarinellaAbstract:The Refeeding Syndrome (RFS) is commonly encoun-tered in hospitalised patients, but is underappreciated by many medical professionals caring for the acutely ill (1,2). In fact, major internal medicine (3) an
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Refeeding Syndrome and hypophosphatemia
Journal of Intensive Care Medicine, 2005Co-Authors: Mark A MarinellaAbstract:Hypophosphatemia is a potentially life-threatening complication of reinstating nutrition in a malnourished patient. Refeeding Syndrome is a term that refers to various metabolic abnormalities that may complicate carbohydrate administration in subnourished patient populations. Hypophosphatemia is the most well-known, and perhaps most significant, element of the Refeeding Syndrome and may result in sudden death, rhabdomyolysis, red cell dysfunction, and respiratory insufficiency. This review briefly examines Refeeding-induced hypophosphatemia in the hospitalized patient in hopes of making clinicians more aware of this common, but often overlooked, potentially dangerous problem.
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the Refeeding Syndrome and hypophosphatemia
Nutrition Reviews, 2003Co-Authors: Mark A MarinellaAbstract:The Refeeding Syndrome is an underappreciated entity characterized by acute electrolyte derangements - notably hypophosphatemia - that occur during nutritional repletion of patients with significant suboptimal caloric intake. Adverse effects of hypophosphatemia include cardiac failure, muscle weakness, immune dysfunction, and death. Hypokalemia and hypomagnesemia commonly complicate Refeeding Syndrome as well; however, this report briefly reviews the clinical manifestations of Refeeding-induced hypophosphatemia.
Susan M Sawyer - One of the best experts on this subject based on the ideXlab platform.
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does aggressive Refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia
Journal of Adolescent Health, 2009Co-Authors: Melissa Whitelaw, Heather Gilbertson, Peiyoong Lam, Susan M SawyerAbstract:Abstract Purpose Concerns about Refeeding Syndrome have led to relatively conservative nutritional rehabilitation in malnourished inpatients with anorexia nervosa (AN), which delays weight gain. Compared to other programs, we aggressively refed hospitalized adolescents. We sought to determine the incidence of hypophosphatemia (HP) in 12–18-year-old inpatients in order to inform nutritional guidelines in this group. Methods A 1-year retrospective chart review was undertaken of 46 admissions (29 adolescents) with AN admitted to the adolescent ward of a tertiary children's hospital. Data collected over the initial 2 weeks included number of past admissions, nutritional intake, weight, height, body mass index, and weight change at 2 weeks. Serum phosphorus levels and oral phosphate supplementation was recorded. Results The mean (SD) age was 15.7 years (1.4). The mean (SD) ideal body weight was 72.9% (9.1). Sixty-one percent of admissions were commenced on 1,900 kcal (8,000 kJ), and 28% on 2,200 kcal (9,300 kJ). Four patients were deemed at high risk of Refeeding Syndrome; of these patients, three were commenced on rehydration therapy and one on 1,400 kcal (6,000 kJ). All patients were graded up to 2,700 kcal (11,400 kJ) with further increments of 300 kcal (1,260 kJ) as required. Thirty-seven percent developed mild HP; no patient developed moderate or severe HP. Percent ideal body weight at admission was significantly associated with the subsequent development of HP ( p = .007). Conclusions These data support more aggressive approaches to nutritional rehabilitation for hospitalized adolescents with AN compared to current recommendations and practice.
Peter W J Harrigan - One of the best experts on this subject based on the ideXlab platform.
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restricted versus continued standard caloric intake during the management of Refeeding Syndrome in critically ill adults a randomised parallel group multicentre single blind controlled trial
The Lancet Respiratory Medicine, 2015Co-Authors: Gordon S Doig, Fiona Simpson, Philippa T Heighes, Rinaldo Bellomo, Douglas Chesher, Ian D Caterson, Michael C Reade, Peter W J HarriganAbstract:Summary Background Equipoise exists regarding the benefits of restricting caloric intake during electrolyte replacement for Refeeding Syndrome, with half of intensive care specialists choosing to continue normal caloric intake. We aimed to assess whether energy restriction affects the duration of critical illness, and other measures of morbidity, compared with standard care. Methods We did a randomised, multicentre, single-blind clinical trial in 13 hospital intensive care units (ICUs) in Australia (11 sites) and New Zealand (two sites). Adult critically ill patients who developed Refeeding Syndrome within 72 h of commencing nutritional support in the ICU were enrolled and allocated to receive continued standard nutritional support or protocolised caloric restriction. 1:1 computer-based randomisation was done in blocks of variable size, stratified by enrolment serum phosphate concentration (>0·32 mmol/L vs ≤0·32 mmol/L) and body-mass index (BMI; >18 kg/m 2 vs ≤18 kg/m 2 ). The primary outcome was the number of days alive after ICU discharge, with 60 day follow-up, in a modified intention-to-treat population of all randomly allocated patients except those mistakenly enrolled. Days alive after ICU discharge was a composite outcome based on ICU length of stay, overall survival time, and mortality. The Refeeding Syndrome Trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR number 12609001043224). Findings Between Dec 3, 2010, and Aug 13, 2014, we enrolled 339 adult critically ill patients: 170 were randomly allocated to continued standard nutritional support and 169 to protocolised caloric restriction. During the 60 day follow-up, the mean number of days alive after ICU discharge in 165 assessable patients in the standard care group was 39·9 (95% CI 36·4–43·7) compared with 44·8 (95% CI 40·9–49·1) in 166 assessable patients in the caloric restriction group (difference 4·9 days, 95% CI −2·3 to 13·6, p=0·19). Nevertheless, protocolised caloric restriction improved key individual components of the primary outcome: more patients were alive at day 60 (128 [78%] of 163 vs 149 [91%] of 164, p=0·002) and overall survival time was increased (48·9 [SD 1·46] days vs 53·65 [0·97] days, log-rank p=0·002). Interpretation Protocolised caloric restriction is a suitable therapeutic option for critically ill adults who develop Refeeding Syndrome. We did not identify any safety concerns associated with the use of protocolised caloric restriction. Funding National Health and Medical Research Council of Australia.
Annalynn Skipper - One of the best experts on this subject based on the ideXlab platform.
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Refeeding Syndrome or Refeeding hypophosphatemia a systematic review of cases
Nutrition in Clinical Practice, 2012Co-Authors: Annalynn SkipperAbstract:Nutrition support clinicians refer to the abnormalities in laboratory data and changes in clinical signs and symptoms that follow Refeeding of starved or malnourished patients as Refeeding Syndrome. Theoretical descriptions of Refeeding Syndrome include a complex and extensive list of changes, such as hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, and vitamin deficiency--all of which are accompanied by clinical signs and symptoms. In practice, clinicians see asymptomatic Refeeding hypophosphatemia more often than a full-blown Syndrome with multiple laboratory and clinical abnormalities. Confusion results because there is no widely accepted or uniformly applied set of defining characteristics for diagnosing Refeeding Syndrome. To gain insight into the clinical characteristics of Refeeding Syndrome described in the literature, a systematic review of reported cases and case series was conducted. Since 2000, 20 authors described 27 cases that contained sufficient data for review. Hypophosphatemia occurred in 26 patients (96%). While 19 patients (71%) experienced at least 1 other laboratory abnormality, only 14 (51%) exhibited a consistent pattern of abnormally low phosphorus and magnesium levels. Seven patients had hypocalcemia (26%), and hyponatremia was reported in 3 patients (11%). There were no reports of hyperglycemia. Mean data reported in case series containing data from 63 patients showed that hypophosphatemia was a consistent finding but that other abnormalities were not consistently identified. Findings suggest that Refeeding hypophosphatemia is not accompanied by a consistent pattern of biochemical or clinical abnormalities among case reports or case series of patients reported to have Refeeding Syndrome.
Krishnan Sriram - One of the best experts on this subject based on the ideXlab platform.
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acute respiratory failure due to Refeeding Syndrome and hypophosphatemia induced by hypocaloric enteral nutrition
Nutrition, 2009Co-Authors: Utpal Patel, Krishnan SriramAbstract:We report a case of acute respiratory failure due to Refeeding Syndrome caused by hypocaloric enteral tube feeds. A 60-y-old obese man, with a diagnosis of esophageal carcinoma with local metastases, underwent feeding jejunostomy tube insertion. Enteral tube feeding was initiated at small volumes providing 4.4 kcal x kg(-1) x d(-1) and gradually increased over 48 h to 29 kcal x kg(-1) x d(-1) (based on adjusted body weight). The patient then developed acute respiratory distress requiring intubation and ventilatory support. Serum phosphorus (P) level was extremely low at 4 d to adequately correct the electrolyte derangements. Successful liberation from mechanical ventilation was then possible. In chronically malnourished patients undergoing nutritional support, even hypocaloric feeding should be considered a risk factor for developing Refeeding Syndrome leading to severe and acute electrolyte fluid-balance and metabolic abnormalities.