Das Refeeding-Syndrom – Eine Literaturübersicht

 

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Zusammenfassung

Das Refeeding-Syndrom ist eine gefährliche, mitunter lebensbedrohliche Komplikation, die nach der Wiederaufnahme einer adäquaten Nahrungszufuhr bei mangelernährten und kachektischen Patienten entstehen kann. Die Entwicklung eines Refeeding-Syndroms wurde nach oraler, enteraler und parenteraler Ernährung beschrieben. Ein frühzeitiges Erkennen eines Refeeding-Syndroms ist für eine adäquate Therapie unumgänglich, jedoch leider aufgrund einer unzureichenden Kenntnis dieses Krankheitsbilds nicht regelhaft. Leitsymptom des Refeeding-Syndroms ist eine Hypophosphatämie. Häufig wird diese von weiteren Elektrolytentgleisungen sowie von Mangelzuständen an Vitaminen und Spurenelementen begleitet. Aufgrund einer Zufuhr an Kohlenhydraten sowie intravenöser Flüssigkeitsgabe kann es zu einer Hypervolämie mit Herzversagen kommen. Weitere Organfunktionsstörungen unterschiedlichen Schweregrads, die bis zum Tod führen können, sind beschrieben worden. Zur Prävention eines Refeeding-Syndroms ist eine frühzeitige Identifikation von Risikopatienten und eine initial niedrige Kalorienzufuhr, begleitet von regelmäßigen laborchemischen Kontrollen unter Nahrungsaufbau, empfehlenswert.

Methoden: Literaturrecherche mit den Begriffen „refeeding syndrome“ sowie „hypophosphataemia“ mit Einbeziehung der NICE-Leitlinien aus dem Jahre 2006.

Abstract

The refeeding syndrome is a dangerous condition, which may even lead to death. The syndrome occurs after re-establishment of adequate nutrition in malnourished and cachectic patients. More specifically its occurrence has been reported during oral, enteral and parenteral feeding. Early diagnosis is crucial for adequate and timely therapy. However, due to a lack of knowledge in the community this is not always achieved. The leading symptom is hypophosphatemia, often accompanied by electrolyte disturbances and vitamin and trace element deficiencies. Due to a concomitant administration of carbohydrates and intravenous fluid volume it may also lead to hypervolemia with cardiac failure. Compromise of other organ functions with a varying degree of severity, even leading to death, have been reported. The most efficient prevention of the refeeding syndrom is recommended by an early identification of patients at risk and the administration of an initially lower caloric nutrition accompanied by a tight and regularly scheduled observation of relevant laboratory parameters.

Methods: This literature research included the following terms: “refeeding syndrome” and “hypophosphataemia” including the 2006 guidelines from the National Institute for Health and Clinical Excellence (UK).

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