Attitudes to NICE guidance on refeeding syndrome

doi:10.1136/bmj.a680

Published 8 July 2008, doi:10.1136/bmj.a680
Cite this as: BMJ 2008;337:a680

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NICE on refeeding syndrome

Attitudes to NICE guidance on refeeding syndrome

The first 150 words of the full text of this article appear below.

Any discussion on the risks of the refeeding syndrome shouldinclude the increased threat of infection that may often besilent in malnutrition.¹ Malnourished patients may develop infectionwithout showing the usual septic markers—such as an increasedtemperature, leucocyte count, or C reactive protein. We thereforeadvocate septic screening and a low threshold for broad spectrumantibiotic cover for any patients with unexplained hypothermia,hypoglycaemia, and evidence of malnutrition.

Patients at high risk of the syndrome may also be at risk ofacute renal failure, which may be missed as they have only slightlyraised urea and creatinine measurements because of low musclemass, leading to low production of these metabolites. When thisoccurs, renal dysfunction may hide low serum and total bodyelectrolyte concentrations, and hence serum potassium, magnesium,and phosphate may be reassuringly normal or even high. Theyare at even greater risk of precipitate falls in these . . . [Full text of this article]

Aminda De Silva, specialist registrar gastroenterology and clinical nutrition¹, Trevor Smith, consultant gastroenterologist², Mike Stroud, consultant gastroenterologist¹

¹ Southampton University Hospital NHS Trust, Southampton SO16 6YD, ² Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW

aminda@doctors.org.uk

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