Malnutrition is a well-established syndrome in geriatric medicine, affecting, in particular, fragile elderly individuals in the hospital and in long-term care facilities. Compensating for nutritional deficiencies is a constant and prevailing feature of medical management in geriatric care. Conversely, the potential dangers of refeeding are less well known in fragile, elderly individuals as compared with the context of intensive care. Over a 5-month observation period, 5 patients in our geriatric medicine ward (2% of all cases) presented refeeding syndrome (Table 1). We present here an illustrative clinical case, and the typical characteristics of refeeding syndrome, with a relevant review of the literature.
Table 1Characteristics of 5 Patients Presenting Refeeding Syndrome Over a 5-Month Period in Our Geriatric Care Unit
|Patient||Age, y||Body Mass Index, kg/m²||Primary Diagnosis||Weight Loss >10% in Past 3 mo||Phosphate
|2||78||18.5||Squamous cell carcinoma, throat cancer||Yes||0.74||0.56||3.2|
|3||80||16.4||Shingles on the chest||Yes||0.73||0.59||3.5|
|4||78||24.0||Cirrhosis, Child-Pugh class B||No||0.62||0.54||4.5|
∗ Normal 0.87–1.45 mmol/L.
† Normal 0.70–1.10 mmol/L.
‡ Norm 3.50–5.10 mmol/L.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Refeeding syndrome: What it is, and how to prevent and treat it.BMJ. 2008; 336: 1495-1498
- Refeeding syndrome or refeeding hypophosphatemia: A systematic review of cases.Nutr Clin Pract. 2012; 27: 34-40
- The importance of the refeeding syndrome.Nutrition. 2001; 17: 632-637
- Refeeding syndrome: Treatment considerations based on collective analysis of literature case reports.Nutrition. 2010; 26: 156-167
- Nutrition assessment and management in amyotrophic lateral sclerosis.Phys Med Rehabil Clin N Am. 2012; 23: 751-771
- Refeeding syndrome: A literature review.Gastroenterol Res Pract. 2011; 2011: 410971
- Refeeding syndrome.Age Ageing. 2002; 31: 65-66
- Evidence-based recommendations for addressing malnutrition in health care: An updated strategy from the feedM.E. Global Study Group.J Am Med Dir Assoc. 2014; 15: 544-550
- Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival.J Intern Med. 2005; 257: 461-468
- Refeeding syndrome—awareness, prevention and management.Head Neck Oncol. 2009; 1: 4
National Institute for Health and Clinical Excellence. Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. NICE clinical guideline [CG] 32. Available at: http://www.nice.org.uk/guidance/CG32. Accessed August 28, 2014.
- Sudden death in eating disorders.Vasc Health Risk Manag. 2012; 8: 91-98
- Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia—the contribution of refeeding syndrome.Gerontology. 2009; 55: 393-397
© 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.