Refeeding Syndrome in Gastrointestinal Patients Receiving Parenteral Nutrition: An Audit of Practice at University College London Hospitals (UCLH)

Abstract

Background: Refeeding Syndrome (RS) is a potentially lethal condition that occurs when feeding is reintroduced to individuals who are malnourished or have experienced prolonged fasting or starvation. This syndrome is characterized by severe electrolyte and fluid shifts, which can lead to complications such as cardiac arrest, respiratory failure, and neurological disturbances. The aim of this audit is to evaluate the management of RS with gastrointestinal patients commencing parental nutrition (PN) at University College London Hospital (UCLH). Method: Data of 18 adult patients starting PN at UCLH were retrospectively collected for 5 days between January to June 2024, using the EPIC software. Patients were evaluated for RS and were stratified and assigned to different risk categories based on the National Institute for Health and Care Excellence (NICE) criteria. This audit compared high-risk and low-risk groups, focusing on biochemical RS (hypokalaemia, hypophosphatemia and hypomagnesemia), alongside other clinical parameters. The American Society of Enteral and Parenteral Nutrition (ASPEN) was utilized to determine the incidence of RS. Statistical analyses were performed using t-tests, Chi-square, and Mann-Whitney U tests. Results: In this audit, 18 gastrointestinal admitted patients undergoing PN were included, men had a significantly lower BMI (p=0.008) and weight (p=0.011) compared to women. According to NICE guidelines, 89% of patients had a higher risk of RS based on risk factors. Hypophosphatemia, hypomagnesemia, and hypokalaemia occurred in 39%, 39%, and 11% of patients, respectively. Electrolyte disturbances were prevalent, especially in the high-risk group. Magnesium collection during PN was missed more frequently than other electrolytes, particularly in high-risk patients. Conclusion: Despite adherence to the recommended guidelines, a proportion of gastrointestinal patients starting PN developed biochemical refeeding syndrome. Nonetheless, high-risk patients were more prone to electrolyte abnormalities, underscoring the need for vigilant monitoring. Further research is necessary to optimize the management and treatment for RS.