Original Article

CME Article: Incidence of Refeeding Syndrome in Pediatric Inpatients at the US–Mexico Border

Authors: Victoria Gonzales, MD, Carlos Lodeiro, MD, Amanda Macias, MD, Denease Francis, MD, Fatima Gutierrez, MD, Indu Pathak MD

Abstract

Objectives: Refeeding syndrome is a life-threatening, physiological process that occurs when patients with severe malnutrition are too rapidly rehabilitated, leading to the development of electrolyte abnormalities. Hypophosphatemia, a hallmark of the disease, has most commonly been studied, because it is recognized to result in cardiac arrhythmias, seizures, cardiac failure, respiratory failure, rhabdomyolysis, coma, and even death. Although many studies have found caloric intake to be a main causal factor in refeeding syndrome, few have explored other factors, such as geographic location. Border cities, such as El Paso, Texas, have a unique, diverse population. The purpose of this study was to establish the incidence of refeeding syndrome concentrated within a border city.

Methods: We performed a retrospective chart review that focused on the incidence of refeeding syndrome in pediatric patients with eating disorders, ages 10 to 19 years, admitted to El Paso Children’s Hospital, the only tertiary teaching hospital in the area, associated with Texas Tech University Health Science Center, located along the US–Mexico border, in El Paso, Texas.

Results: Twenty-six subjects with a diagnosis of eating disorder were admitted to El Paso Children’s Hospital for treatment between 2012 and 2019. Five subjects developed refeeding syndrome, recognized in our study as hypokalemia or hypomagnesemia, during their treatment.

Conclusions: Among hospitalized adolescents admitted to El Paso Children’s Hospital, 19% developed refeeding syndrome. This incidence was higher in our population than had been previously reported. Further research is needed to better establish a protocol for the treatment of patients with eating disorders.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. O’Connor G. and Nicholls D. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutr Clin Pract 2013;28:358–364.
 
2. Gonzalez A, Kohn MR, Clarke SD. Eating disorders in adolescents. Aust Fam Physician 2007;36:614–619.
 
3. Katzman DK. Medical complications in adolescents with anorexia nervosa: a review of the literature. Int J Eat Disord 2005;37(suppl):S52–S59, S87–89.
 
4. Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health 2014;56:19–24.
 
5. Kerzner B, Milano K, MacLean WC, et al. A practical approach to classifying and managing feeding difficulties. Pediatrics 2015;135:344–353.
 
6. Garber AK, Michihata N, Hetnal K, et al. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health 2012;50:24–29.
 
7. Garber AK, Machen VI, Cheek Park C, et al. Changing approaches to refeeding malnourished patients with eating disorders: results of an international survey. J Adolesc Health 2018;62(suppl):S100.
 
8. Schnitker MA, Mattman PE, Bliss TL. A clinical study of malnutrition in Japanese prisoners of war. Ann Intern Med 1951;35:69–96.
 
9. Byrnes MC, Stangenes J. Refeeding in the ICU: an adult and pediatric problem. Curr Opin Clin Nutr Metab Care 2011;14:186–192.
 
10. Ornstein RM, Golden NH, Jacobson MS, et al. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolesc Health 2003;32:83–88.
 
11. Pulcini CD, Zettle S, Srinath A. Refeeding syndrome. Pediatr Rev 2016;37:516–523.
 
12. Rytter MJh, Babirekere-Iriso E, Namusoke H, et al. Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study. Am J Clin Nutr 2017;105:494–502.
 
13. O’Connor G, Nicholls D, Hudson L, et al. Refeeding low weight hospitalized adolescents with anorexia nervosa: a multicenter randomized controlled trial. Nutr Clin Pract 2016;31:681–689.
 
14. Dunn RL, Stettler N, Mascarenhas MR. Refeeding syndrome in hospitalized pediatric patients. Nutr Clin Pract 2003;18:327–332.
 
15. Ghaddar R, Chartrand J, Benomar A, et al. Excessive laboratory monitoring to prevent adolescent’s refeeding syndrome: opportunities for enhancement. Eat Weight Disord 2020;25:1021–1027.
 
16. Stanga Z, Brunner A, Leuenberger M, et al. Nutrition in clinical practice— the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr 2008;62:687–694.
 
17. Mehanna H, Nankivell PC, Moledina J, et al. Refeeding syndrome— awareness, prevention and management. Head Neck Oncol 2009;1:4.
 
18. Ibrahim IB, Hussain AA, Sjögren JM. The refeeding syndrome in anorexia nervosa. Ugeskr Laeger 2018;180:V06170463.