2118P - Refeeding syndrome: A prospective analysis in adults admitted to an oncology hospital

Background

The refeeding syndrome is a potentially lethal condition, associated with metabolic alterations after food reintroduction, and subsequent increase in nutritional intake. It occurs especially in malnourished patients, or in a hyper-catabolic stage. Particularly oncological diseases represent an increased risk factor for the manifestation of the syndrome. Data related to the oncological population is rarely reported, except for the various case series/case studies published to date.This study aims to determine the prevalence of refeeding syndrome in oncological patients according to their risk and to develop a clinical pathway to address and monitor this syndrome.

Methods

A prospective longitudinal study was carried out on 124 patients who started exclusive support via parenteral or enteral nutrition, in 4 units of the oncology hospital: intensive care, intermediate care, medical and surgical inpatient units. Risk for refeeding syndrome was determined as follows: low risk, moderate, high. Biochemistry available (ionogram) before feeding, and its evolution over the first 5 days after initiation was evaluated.

Results

In 64% of patients, serum phosphate, potassium, and magnesium measurements were available prior to nutritional support. There was no information on serum phosphate in 29.7% of patients, with no significant differences between surgical and medical patients. After 48 hours, serum concentration variations were especially pronounced in patients without electrolyte supplementation prior to feeding (-18.2%) versus previously supplemented (10.3%) (p=0.035). After 72 hours, 31.8% of patients experienced reductions superior to 30% in the ionogram, compatible with refeeding syndrome. A positive Spearman's correlation (0.69, p=0.017) was identified between the initially assessed risk (moderate and high) and the decrease in phosphate (>20%) observed at the end of 48 hours in non-supplemented patients.

Conclusions

There is a high prevalence of refeeding syndrome in cancer patients. Monitoring should be continuous, including hypophosphatemia. By providing a multidisciplinary intervention and allowing the provision of micronutrients at the appropriate time, complications of the syndrome can be avoided.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Instituto Português de Oncologia do Porto Francisco Gentil (IPO).

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.