Joshua S V da Silva1, David S Seres2, Kim Sabino3, Stephen C Adams4, Gideon J Berdahl5, Sandra Wolfe Citty6, M Petrea Cober7,8, David C Evans9, June R Greaves10, Kathleen M Gura11, Austin Michalski12, Stephen Plogsted13, Gordon S Sacks14, Anne M Tucker15, Patricia Worthington16, Renee N Walker17, Phil Ayers18. 1. Boonshoft Emergency Medicine Residency Program, Kettering, Ohio, USA. 2. Columbia University Irving Medical Center, New York, New York, USA. 3. Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA. 4. VITALine Infusion Pharmacy Service, Danville, Pennsylvania, USA. 5. School of Pharmacy, University of Mississippi, Jackson, Mississippi, USA. 6. College of Nursing, University of Florida, Gainesville, Florida, USA. 7. Akron Children's Hospital, Akron, Ohio, USA. 8. Northeast Ohio Medical University, Rootstown, Ohio, USA. 9. Ohio Health Trauma and Surgical Services, Columbus, Ohio, USA. 10. Coram CVS Speciality Infusion Services Northbrook, Illinois, USA. 11. Boston Children's Hospital, Boston, Massachusetts, USA. 12. Patient Food and Nutrition Services, Michigan Medicine, Ann Arbor, Michigan, USA. 13. Nutrition Support Service, Nationwide Children's Hospital, Columbus, Ohio, USA. 14. Medical Affairs, Fresenius Kabi USA LLC, Lake Zurich, Illinois, USA. 15. Critical Care and Nutrition Support, University of Texas M D Anderson Cancer Center, Houston, Texas, USA. 16. No affiliation. 17. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. 18. Clinical Pharmacy Services, Mississippi Baptist Medical Center, Jackson, Mississippi, USA.
Abstract
INTRODUCTION: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. METHODS: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. FINDINGS/RECOMMENDATIONS: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. CONCLUSIONS: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
INTRODUCTION: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. METHODS: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. FINDINGS/RECOMMENDATIONS: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamindeficiency (severe), occurring within 5 days of reintroduction of calories. CONCLUSIONS: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.