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Refeeding syndrome in the frail elderly population: prevention, diagnosis and management

Authors Aubry E, Friedli N, Schuetz P, Stanga Z

Received 19 December 2017

Accepted for publication 10 April 2018

Published 10 July 2018 Volume 2018:11 Pages 255—264


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Wing-Kin Syn

Emilie Aubry,1 Natalie Friedli,2 Philipp Schuetz,2 Zeno Stanga1

1Department for Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland; 2Medical University Department, Clinic for Endocrinology, Diabetes, Metabolism and Clinical Nutrition, Kantonsspital Aarau, and Medical Faculty of the University of Basel, Basel, Switzerland

Abstract: Aging is linked to physiological and pathophysiological changes. In this context, elderly patients often are frail, which strongly correlates with negative health outcomes and disability. Elderly patients are often malnourished, which again is an independent risk factor for both frailty and adverse clinical outcomes. Malnutrition and resulting frailty can be prevented by adequate nutritional interventions. Yet, use of nutritional therapy can also have negative consequences, including a potentially life-threatening metabolic alteration called refeeding syndrome (RFS) in high-risk patients. RFS is characterized by severe electrolyte shifts (mainly hypophosphatemia, hypomagnesemia and hypokalemia), vitamin deficiency (mainly thiamine), fluid overload and salt retention leading to organ dysfunction and cardiac arrhythmias. Although the awareness of malnutrition among elderly people is well established, the risk of RFS is often neglected, especially in the frail elderly population. This partly relates to the unspecific clinical presentation and laboratory changes in the geriatric population. The aim of this review is to summarize recently published recommendations for the management of RFS based on current evidence from clinical studies adapted with a focus on elderly patients.

Keywords: refeeding syndrome, frail, elderly, management, malnutrition

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