Síndrome de Realimentación
[Refeeding Síndrome]Laura Fernandez Castañeda1, Edwin Araúz2, Abdullah Salehji3
1. Servicio de Medicina Interna, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panamá, Rep. de Panamá; 2. Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panamá, República de Panamá; 3. Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panamá, República de Panamá .
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Resumen
El Síndrome de Realimentación (SR) ocurre posterior a la reintroducción de dieta enteral, parenteral u oral en pacientes con malnutrición; caracterizándose por alteraciones metabólicas y electrolíticas que aparecen cinco días después de la introducción del aporte calórico. Su incidencia y mortalidad es variable debido a la baja sospecha diagnóstica y desconocimiento del tema. La aparición de las manifestaciones clínicas depende de la alteración electrolítica; por lo general afectando múltiples sistemas. La prevención se basa en la identificación de individuos con factores de riesgo, instaurar un régimen nutricional adecuado y constante monitorización durante la realimentación. El manejo multidisciplinario es dirigido a la corrección de los trastornos hidroelectrolíticos y correcto inicio y optimización de la nutrición. Representa una entidad subdiagnosticada ya que no existen criterios universalmente establecidos. A pesar de que hoy en día, existe mayor conocimiento sobre la fisiología y fisiopatología de la enfermedad, la presentación inespecífica de los síntomas requiere un alto grado de sospecha para el diagnóstico. Por esta razón, la importancia de esta revisión.
Abstract
Refeeding Syndrome (RS) occurs after the reintroduction of enteral, parenteral or oral diet in patients with malnutrition; it is characterized by metabolic and electrolyte alterations that appear five days after the introduction of caloric intake. Its incidence and mortality is variable due to the low diagnostic suspicion and lack of knowledge on the subject. The appearance of clinical manifestations depends on the electrolyte alteration, usually affecting multiple systems. Prevention is based on the identification of individuals with risk factors, establishing an adequate nutritional regimen and constant monitoring during refeeding. Multidisciplinary management is directed to the correction of water and electrolyte disorders and correct initiation and optimization of nutrition. It represents an underdiagnosed entity since there are no universally established criteria. Although nowadays, there is greater knowledge about the physiology and pathophysiology of the disease, the non-specific presentation of symptoms requires a high degree of suspicion for diagnosis. For this reason, the importance of this review.
Citas
[1] Heuft L, Voigt J, Selig L, Stumvoll M, Schlögl H, Kaiser T. “Refeeding Syndrome—Diagnostic Challenges and the Potential of Clinical Decision Support Systems.” Deut-sches Ärzteblatt International, Feb. 2023. DOI.org (Crossref), https://doi.org/10.3238/arztebl.m2022.0381.
[2] Da Silva J, Seres D, Sabino K, et al. “ASPEN Consensus Recommendations for Refeeding Syndrome.” Nutrition in Clinical Practice, vol. 35, no. 2, Apr. 2020, pp. 178–95. DOI.org (Crossref), https://doi.org/10.1002/ncp.10474
[3] Araujo Castro M, VVázquez Martínez C. El síndrome de realimentación. Impor-tancia del fósforo. Med Clin (Barc). 2018. https://doi.org/10.1016/j.medcli.2017.12.008
[4] Kraaijenbrink B, Lambers W, Mathus-Vliegen E, Siegert C. Incidence of Refeeding syndrome in internal medicine patients. Neth J Med. 2016 Mar;74(3):116-21. PMID: 27020991.
[5] Cioffi I, Ponzo V, Pellegrini M, et al. “The Incidence of the Refeeding Syndrome. A Systematic Review and Meta-Analyses of Literature.” Clinical Nutrition, vol. 40, no. 6, June 2021, pp. 3688–701. DOI.org (Crossref), https://doi.org/10.1016/j.clnu.2021.04.023.
[6] Janssen G, Pourhassan M, Lenzen-Großimlinghaus R, et al. The Refeeding Syn-drome revisited: you can only diagnose what you know. Eur J Clin Nutr. 2019. Dispo-nible en: https://doi.org/10.1038/s41430-019-0441-x.
[7] Ornstein RM, Golden NH, Jacobson MS, Shenker IR. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolescent Health. 2003 Jan;32(1):83-8. doi: 10.1016/s1054-139x(02)00456-1. PMID: 12507806.
[8] Hershkowitz E, Reshef A, Munich O, Yosefi B, Markel A. “Thiamine Deficiency in Self-Induced Refeeding Syndrome, an Undetected and Potentially Lethal Condition.” Case Reports in Medicine, vol. 2014, 2014, pp. 1–6. DOI.org (Crossref), https://doi.org/10.1155/2014/605707.
[9] Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma con-centrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005 Jul;82(1):163-73. doi: 10.1093/ajcn.82.1.163. PMID: 16002815.
[10] Chiappetta S, Stein J. “Refeeding Syndrome: An Important Complication Following Obesity Surgery.” Obesity Facts, vol. 9, no. 1, 2016, pp. 12–16. DOI.org (Crossref), https://doi.org/10.1159/000442534.
[11] Hammami S, Aref HL, Khalfa M, Kochtalli I, Hammami M. Refeeding syn-drome in adults with celiac crisis: a case report. J Med Case Rep. 2018 Jan 31;12(1):22. doi: 10.1186/s13256-018-1566-6. PMID: 29382373; PMCID: PMC5791168.
[12] Korbonits M, Blaine D, Elia M, Powell-Tuck J. “Metabolic and Hormonal Changes during the Refeeding Period of Prolonged Fasting.” European Journal of Endocrinology, vol. 157, no. 2, Aug. 2007, pp. 157–66. DOI.org (Crossref), https://doi.org/10.1530/EJE-06-0740.
[13] Bunge P, Frank L. “A Case of Refeeding Syndrome in a Marine Recruit.” Military Medicine, vol. 178, no. 4, Apr. 2013, pp. e511–15. DOI.org (Crossref), https://doi.org/10.7205/MILMED-D-12-00218.
[14] Lapinskienė I, Mikulevičienė G, Dragelytė G, Bagaras R. “Consequences of an Extreme Diet in the Professional Sport: Refeeding Syndrome to a Bodybuilder.” Clinical Nutrition ESPEN, vol. 23, Feb. 2018, pp. 253–55. DOI.org (Crossref), https://doi.org/10.1016/j.clnesp.2017.10.003.
[15] Marinella MA. Refeeding syndrome: an important aspect of supportive on-cology. J Support Oncol. 2009 Jan-Feb;7(1):11-6. PMID: 19278172.
[16] Aubry E, Friedli N, Schuetz P, Stanga Z. Refeeding Syndrome in the frail elderly population: Prevention, diagnosis and management. Clin Exp Gastroenterol. 2018; 11: 255–64.
[17] Boot R, Koekkoek K, van Zanten A. Refeeding Syndrome: relevance for the critically ill Patient. Curr Opin Crit Care. 2018 ;24(4):235-40.
[18] Friedli N, Stanga Z, Culkin A, Crook M, Laviano A, Sobotka L, et al. Man-agement and Prevention of Refeeding Syndrome in Medical Inpatients: An evidence-based and consensus-supported algorithm, Nutrition (2017), doi: 10.1016/j.nut.2017.09.007.
[19] Friedli N, Stanga Z, Sobotka L, Culkin A, Kondrup J, Laviano A,et al. Revis-iting the Refeeding Syndrome: Results of a Systematic Review. Nutrition. 2017;35:151-60. Doi: 10.1016/j.nut.2016.05.016. Epub 2016. PMID: 28087222.
[20] Friedli N, Odermatt J, Heber E, Schuetz P, Stanga Z. “Refeeding Syn-drome: Update and Clinical Advice for Prevention, Diagnosis and Treatment.” Current Opinion in Gastroenterology, Dec. 2019, p. 1. DOI.org (Crossref), https://doi.org/10.1097/MOG.0000000000000605.
[21] McKnight CL, Newberry C, Sarai M, Martindale R, Hurt R, Daley B. “Refeeding Syndrome in the Critically Ill: A Literature Review and Clinician’s Guide.” Current Gastroenterology Reports, vol. 21, no. 11, Nov. 2019, p. 58. DOI.org (Crossref), https://doi.org/10.1007/s11894-019-0724-3.
[22] Khan LUR, Ahmed J, Khan S, MacFie J. “Refeeding Syndrome: A Litera-ture Review.” Gastroenterology Research and Practice, vol. 2011, 2011, pp. 1–6. DOI.org (Crossref), https://doi.org/10.1155/2011/410971.
[23] Reber E, Friedli N, Vasiloglou M, Schuetz P, Stanga Z. “Management of Refeeding Syndrome in Medical Inpatients.” Journal of Clinical Medicine, vol. 8, no. 12, Dec. 2019, p. 2202. DOI.org (Crossref), https://doi.org/10.3390/jcm8122202.
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