RS refers to electrolyte and metabolic alterations that occur due to increased or reintroduction of calories after a prolonged lack or decreased consumption. Calories, in this situation, can be from many sources ranging from oral diet and PN to enteral nutrition. To the article, RS was initially explained in World War II when most prisoners reportedly experienced high mortality and morbidity due to depletion of food.
According to the article, regular energy intake may result from changes in metabolic substrates. However, an extended period of low nutrition intake may result in low chances of survival which entirely depends on the body’s ability to use reserves of energy available. As the level of hunger becomes intense, the number of energy stores and electrolytes sometimes are exhausted. This reduction is normally worsened by intestinal content loss and diarrhea which exacerbates the patient’s condition.
Patients at the risk of RS struggle to be identified through current screening methods as there is no consensus on a standard accepted definition. As a result, the RS condition is first identified through a subjective means by a clinician during the enteral time or PN examination. In simple terms, the screening strategy does not give actual levels of hypomagnesemia and hypokalemia. The article demonstrates that SGA patients are at higher risk of hypophosphatemia among neonates. On the same note, increased artery resistance was a significant contributor to the development of the condition. Following low urinary excretion of potassium and phosphorus suggested that the condition had negative correction with such loss.
Although the RS incidence in most of the population remains unknown, there are categories of people more prone than others. The first category is Anorexia Nervosa which is linked to self-restriction leading to excess weight reduction. Some patients are reported to have isolated malnourishment, with some having no clinical comorbidities, distinguishing them from others in the hospital (da Silva et al., 2020). In addition, individuals with mental disorders are at high risk of contracting RS resulting from inappropriate dieting caused by self-neglect and general nutrition evasion.
Moreover, individuals with alcohol-use illness are said to emanate from a diet deficiency. Although the article acknowledges the lack of adequate research in this field, it is required that the RS risk among alcoholic patients need to be considered due to global malnourishment evidence. Likewise, patients with cases of methamphetamine, heroin, and other substance abuse need to be monitored for RS due to the high risk of malnourishment. Additionally, child abuse victims are known for malnutrition, resulting in RS cases, especially in their recovery. As evidenced in most developing countries, due to neglect by caregivers, Starvation of children also results in high RS among youngsters. The article shows that athletes and the military are at increased risk of RS due to increased weight loss resulting from their scheduled exercises.
As evidenced in the article, there is no straightforward guide on safely intervening on nutrition issues. Most of the available recommendations are general as they advocate for slow to moderate energy increases. Other proposals from the article include supplementing electrolytes to increase energy through the addition of phosphate. The slow rate of intervention in light of the required quick weight gain among high-risk patients is seen to be undesirable. Therefore, the article clearly explains the syndrome, risk factors, and population alongside RS treatment. The author requires RS patients to be served with conservative calories followed by close monitoring for electrolyte abnormalities.
Reference
da Silva, J. S., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W.,… & Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. (2020). ASPEN consensus recommendations for refeeding syndrome. Nutrition in Clinical Practice, 35(2), 178-195. Web.