In severely malnourished individuals, it is essential to restore nutrition as soon as possible. Therefore, people with disabilities are often encouraged to eat well again. Here, however, caution is advised: If he ingests too many nutrients in a short time, it can cause supplementation syndrome – with fatal consequences.
The syndrome has been documented since ancient times
The syndrome was first described by the Jewish-Roman historian Flavius Josephus in the first century AD. This documented the unexpected deaths of many Jews who escaped from Roman captivity. Due to long-term starvation, the prisoners ate a disproportionate amount of food after fleeing and subsequently died. From a medical history point of view, a similar phenomenon was observed in prisoners of Nazi concentration camps and Japanese prisoners of war after the end of World War II. When, after a long period of fasting, they regained normal eating habits, unexpectedly severe symptoms of heart failure with neurological complications appeared. Subsequent medical research has shown a clear link between supplementation and cardiovascular problems. At present, patients with anorexia nervosa are particularly affected by nutritional therapy.
Medical observations suggest that the symptoms occur mainly with venous glucose infusions. However, symptoms can also develop during oral intestinal intake or artificial nutrition. The syndrome often manifests itself within the first four days after resuming a normal diet. Cardiovascular disorders, tissue water retention and acute vitamin B1 deficiency are the first symptoms. The severity of the symptoms depends to a large extent on the length of the previous starvation and the degree of malnutrition.
Fatal glucose intake
In most cases, refeeding syndrome is caused by an unbalanced mineral metabolism after a chronic lack of food. After only two days without food, the body no longer has any carbohydrate reserves and begins to degrade fat intensively. In addition, the concentration of essential minerals and vitamins is constantly decreasing. If there is a greater supply of glucose after a long period of fasting, the pancreas immediately releases insulin to boost energy production in the cells. However, burning glucose requires several important vitamins and minerals, especially vitamin B1 and phosphate. While phosphate contributes to the formation of the vital energy supply ATP, vitamin B1 catalyzes the breakdown of glucose.
Electrolyte imbalance causes symptoms
Not only phosphates but also magnesium and potassium ions are absorbed in the cells during energy production. Electrolyte balance is severely unbalanced in the face of previous food shortages – while minerals continue to increase intercellularly, there is still a significant shortage in the extracellular range. This imbalance causes the blood vessels to become leaky, allowing fluid to accumulate in the tissues. In addition, a disproportionate amount of insulin retains water in the body, which can lead to heart and kidney complications.
therapy and prevention
In order to prevent the development of refeeding syndrome, it is essential to replace deficient electrolytes and vitamins before and during the restoration of a regular diet. At the same time, the blood electrolyte concentration should be checked regularly to ensure proper dosing. As part of the therapy, it is appropriate to continuously increase the physiological food intake. At the beginning, a daily intake of about 15 kcal per kilogram is recommended. To avoid serious complications, malnourished patients should be treated under medical supervision. After successful therapy, it is advisable to rely on a diet rich in vitamins and minerals to achieve a healthy metabolism. People with disabilities should also include protein and carbohydrate foods in their diet so that malnutrition does not recur.