Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

Refeeding syndrome is a life-threatening condition that occurs when nutrition is restarted in patients with initial malnutrition. For the first time refeeding syndrome was described more than 70 years ago but it still has not been studied enough. The pathophysiology of refeeding syndrome is based on severe electrolyte and metabolic disorders caused by the restoration of nutrition with an initial deficiency of phosphorus, potassium, magnesium which lead to organ failure. Hypophosphatemia is the main feature of the refeeding syndrome while in ICU patients there are many other causes of hypophosphatemia which complicates diagnostics. Most studies on refeeding syndrome have been conducted among patients with anorexia nervosa. In ICU refeeding hypophosphatemia occurs in about 34 % of cases but until recently all guidelines for the management of this condition have been extrapolated from the practice of treatment anorexia nervosa and were based on expert opinion. Several major studies have proven the effectiveness of a hypocaloric feeding during refeeding syndrome in critically ill patients recently. This review is devoted to the problem of refeeding syndrome in patients with anorexia nervosa and critical care patients, differential diagnostics and treatment approaches for this condition.