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Refeeding Syndrome (RS) is poorly understood and remains under-diagnosed, -despite its clinical consequences and the risk of death. It is defined by the clinical and biological manifestations that occur during the refeeding of patients after prolonged fasting or in the context of undernutrition. It results from the abrupt shift from catabolism to anabolism. The intracellular displacement of electrolytes (phosphorus, magnesium, potassium) in response to insulin secretion after -refeeding, and thiamine (vitamin B1) deficiency, play a major role in the pathophysiology of RS. Clinical symptoms are associated with hydroelectrolyte disorders, -hydrosaline retention, and/or organ failure. Patient management should be immediate with regular clinical examinations and close biological monitoring, including electrolytes monitoring. Correction of hydroelectrolyte disorders and systematic thiamine supplementation are essential during refeeding. Whether oral, enteral, or parenteral, refeeding should be cautious and very progressively. Identifying patients at risk of RS and preventive measures are crucial. [ABSTRACT FROM AUTHOR]

Résumé: La dénutrition, souvent sous-diagnostiquée, affecte plus de la moitié des patients en oncologie digestive, avec une prévalence plus élevée chez les patients âgés et en cas de tumeur à un stade avancé. Elle a de multiples conséquences négatives sur la survie, la qualité de vie, avec notamment une augmentation de la fréquence des complications des traitements oncologiques et de la durée d'hospitalisation. La dénutrition est multifactorielle en lien avec une diminution des apports et une augmentation des dépenses protéino-énergétiques. Ainsi, en parallèle des traitements anti-tumoraux classiques, les soins de support incluant la nutrition et l'activité physique occupent une place centrale dans la prise en charge des cancers digestifs. Le dépistage systématique précoce de la dénutrition, basé sur des critères mis à jour par la Haute Autorité de Santé en 2019, est indispensable pour la prévenir et la traiter au diagnostic et à toutes les étapes de la prise en charge. Dans ce contexte, un nouveau chapitre consacré à l'évaluation et la prise en charge nutritionnelle et de l'activité physique en oncologie digestive est venu compléter le Thésaurus National de Cancérologie Digestive (TNCD) en 2020. L'objectif de cette mini-revue est d'en résumer les principaux éléments de recommandation de prise en charge nutritionnelle en cancérologie digestive à toutes les étapes (péri-opératoire, durant la radiothérapie, durant les traitements systémiques, à la phase palliative et après le cancer) en 2020. Malnutrition is often underdiagnosed and affects more than half of patients with digestive cancers, especially in older patients and those with an advanced disease. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Malnutrition pathophysiology is multifactorial and results from the negative imbalance between decreased energy and protein intakes and increased expenditures. Consequently, in addition to anticancer treatments, supportive care including nutritional support and physical activity plays a central role in the management of digestive cancers. It is crucial to early detect malnutrition (diagnostic criteria updated in 2019), to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition in digestive oncology at each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé La thiamine (vitamine B1) est une vitamine hydrosoluble présente dans la levure de bière, la pulpe des fruits crus, les germes de céréales et les produits d’origine animale. Après absorption, elle est phosphorylée dans le foie et est un cofacteur d’enzymes intervenant dans le métabolisme énergétique et de l’alcool. Le magnésium est un cofacteur impliqué dans son métabolisme et son déficit est un facteur de résistance à la supplémentation. Les réserves sont quasi inexistantes. En dehors de l’alcoolisme, le déficit est lié à une carence d’apport, secondaire à vomissements ou diarrhée, à une malabsorption ou à une alimentation riche en glucide et carencée en vitamine B1 ou certains médicaments. Une forte susceptibilité génétique est en cause. Son dosage sanguin est faiblement contributif, ne représentant qu’un faible proportion du stock de l’organisme. Au niveau clinique, la forme « sèche » neurologique est l’encéphalopathie de Gayet-Wernicke, associée ou non à un syndrome de Korsakoff et la polynévrite résultant de carences multiples. La forme dite « humide » est une insuffisance cardiaque. La prévention de cette carence doit être systématique chez tout patient qui présente des troubles digestifs et une carence d’apport et chez tout patient à risque de syndrome de renutrition inappropriée. En cas de signes neurologiques évocateurs, le traitement doit être mis en route sans attendre les résultats du dosage et associé à une supplémentation en magnésium. Il faut prévenir et traiter de façon empirique tout patient suspect de carences, sans se préoccuper des résultats des dosages plasmatiques. Thiamine (vitamin B1) is a water-soluble vitamin. The richest natural sources are brewer's yeast, raw fruits (in the pulp) and cereal germs, but also animal products. It is absorbed by active and saturable transport in the proximal small intestine and phosphorylated in the liver (into an active form). It is an essential cofactor of enzymes involved in energy and alcohol metabolism. Magnesium is a major cofactor involved in the metabolism of thiamine and a factor of resistance to supplementation. Thiamine flows in the formed elements of the blood and stocks are virtually nil, so signs of deficiency can appear quickly. The causes of deficiency are often multifactorial. Apart from alcoholism, insufficient intake is due to digestive symptoms (vomiting, diarrhea) or malabsorption, or a carbohydrate rich diet and poor in thiamine. Some medications may also worsen the deficit. A high genetic susceptibility may explain the variability of clinical presentations, i.e. dry vs. wet B1 deficiency. The testing of blood vitamin B1 is weakly contributory, since it only represents a very small proportion of the body's stock. Two clinical presentations are conventionally described: the “dry” is the neurological one: Wernicke encephalopathy, sometimes associated with a Korsakoff syndrome, and a polyneuropathy, resulting mainly from nutritional disorders including deficiencies in all group B vitamins; its prevalence is largely underestimated; the “wet” one mainly includes cardiac insufficiency. The prevention of these clinical deficiencies must be systematic in all patients with digestive disorders, including prolonged vomiting and diarrhea, and in any patient at risk of refeeding syndrome, a situation also described after digestive surgery, especially obesity surgery, using oral or parenteral supplementation. In case of evocative neurological symptoms, B1 supplementation must be initiated without delay, combined with a magnesium supplementation, and without waiting for the blood test results. The absence of B1 toxicity, even with large doses, and the imperfection of biological markers encourage the preventive and empirical treatment of all patients suspected of thiamine deficiency, without worrying about blood level. [ABSTRACT FROM AUTHOR]

Résumé Depuis près de 40 ans, la dénutrition est considérée comme une maladie hospitalière. Or force est de constater que cette dénutrition a pris naissance en amont dans la communauté et qu’un dépistage hospitalier même précoce reste tardif lorsque l’on considère l’histoire évolutive de cette pathologie. Durant l’hospitalisation, l’état nutritionnel se détériore fréquemment et dans les situations les plus favorables de traitement, les durées de séjour de plus en plus courtes n’en permettent que rarement la correction totale. La coordination avec le réseau de soins du domicile devient alors seule garante de la poursuite des traitements nutritionnels initiés à l’hôpital. La Haute Autorité de santé met en place depuis 2012 différents parcours de soins qui impliquent le patient ainsi que les professionnels de ville médicaux, paramédicaux et médico-sociaux dans la prévention, le repérage précoce de la dénutrition et dans sa prise en charge à domicile. Le temps est venu de considérer que comme toute autre maladie chronique, quel que soit l’âge du patient, la dénutrition requiert un parcours de soins spécifique. Malnutrition has been considered as a hospital illness for nearly forty years. Despite this fact, we know this malnutrition finds its roots earlier within the community. Therefore, considering the evolutionary history of this pathology even an early hospital screening proves to be overdue. Nutritional condition often deteriorates during hospitalization and, with most favorable treatment conditions, increasingly short lengths of stay rarely allow for a complete correction. Coordination with home care network becomes essential to maintain nutritional treatment that was initiated in hospital. Since 2012, French health authorities proposes different care pathways involving patients as well as doctors, paramedical and medico-social practitioners in malnutrition prevention, early detection and home medical care. It is now essential to consider that malnutrition, like any chronic disease, asks for a specific care pathway, whatever the age of the patient. [ABSTRACT FROM AUTHOR]

Résumé L’agression qui conduit le patient en réanimation s’accompagne souvent d’un hypercatabolisme qui, avec l’inflammation et l’immobilisation, va contribuer à une déplétion de la masse maigre, en particulier de la masse musculaire. Une dette en énergie se constitue au cours de la première semaine de réanimation ; son importance est associée à un accroissement de la morbidité surtout infectieuse. En réanimation, le recours à une nutrition artificielle est indispensable lorsque le patient ne peut couvrir ses besoins nutritionnels par l’alimentation orale dans les 72 heures suivant l’admission. La nutrition entérale (NE) doit être le premier choix et celle-ci doit être débutée, en l’absence de contre-indication, dans les 24 premières heures suivant l’admission. Le débit de NE doit être augmenté progressivement afin de parvenir si possible dans les 48 heures à la cible énergétique (20–25 kcal/kg/j) ; la cible protéique est comprise entre 1,2 et 1,5 g/kg/j. Cependant, l’intolérance digestive est fréquente. Dans ce cas, l’utilisation de prokinétiques est à envisager. Lorsque les apports entéraux deviennent insuffisants, l’utilisation d’une NE en site jéjunal ou d’une nutrition parentérale complémentaire peuvent s’avérer nécessaire, cette dernière pouvant s’associer à une amélioration du devenir clinique. Si une dénutrition préexiste, le risque de syndrome de renutrition inappropriée est élevé. Tout trouble hydro-électrolytique doit être corrigé avant l’initiation de la nutrition artificielle. Le débit de NE doit être augmenté lentement sous surveillance biologique rapprochée, en particulier de la kaliémie, de la natrémie et la phosphorémie. L’apport de vitamines et d’oligo-éléments est indispensable. En revanche, l’immunonutrition entérale n’a pas fait la preuve de son utilité. La nutrition artificielle fait partie intégrante de la prise en charge du patient de réanimation au même titre que la ventilation et l’hémodynamique. Une surveillance spécifique est indispensable pour prévenir tout risque de sur- ou sous-nutrition et optimiser le devenir clinique. Major stress such as severe trauma, infection or postoperative state, is frequently associated with increased catabolism and energy expenditure. These contribute to fat-free mass loss. The increase of energy debt in the first week of intensive care unit (ICU) stay is associated with an increase in infectious complications and length of mechanical ventilation and ICU stay. When oral intake is insufficient to cover nutritional needs after the three first days of ICU stay, enteral nutrition (EN) is the first choice and should be started within 24 hours. The volume of daily EN should be gradually increased to reach the target within 48 hours (20–25 kcal/kg/day). Protein provision must be 1.2–1.5 g/kg/day. However, enteral feeding could be poorly tolerated by ICU patients due to impaired gastrointestinal motility. In case of gastroparesis, prokinetics can be administered according to previously established protocol. Nevertheless, the use of supplemental parenteral nutrition (PN) or jejunal EN could be necessary in case of failure or insufficient gastric EN. In the ICU, enteral immunonutrition is not indicated because of the absence of additional benefits. Undernutrition prior to admission is likely to worsen during the ICU stay. In case of preexisting undernutrition, the risk of refeeding syndrome is high. EN must be increased very cautiously under tight monitoring of plasma electrolytes, including phosphates, potassium, sodium, calcium, and magnesium. An electrolyte supplementation is warranted in case of plasma deficiencies, along with vitamins and trace elements. Nutrition support is taking part of the management of the ICU patient, as ventilation and hemodynamics. Specific nutritional monitoring is essential to prevent any risk of over- or undernutrition, and to optimize clinical outcome. [ABSTRACT FROM AUTHOR]

Résumé: L’anorexie mentale restrictive de l’adulte est un trouble du comportement alimentaire que l’on rencontre quotidiennement dans les consultations de nutrition et régulièrement dans les consultations de médecine générale. Souvent dans le déni, les patients sont amenés à consulter tardivement avec des conséquences nutritionnelles et métaboliques qui peuvent engager le pronostic vital. Bien que de nosographie psychiatrique, la prise en charge multidisciplinaire est fortement recommandée. Le cas clinique suivant présente une patiente âgée de 20ans, adressée en consultation de nutrition par son médecin traitant pour ű anorexie mentale depuis six mois suite à une rupture sentimentale Ƈ avec perte de poids de 12kg en huit mois. [ABSTRACT FROM AUTHOR]

A 65 year old alcoholic man was hospitalized because he was tired, hypotonic, with postural tremor. The neurologic symptoms increased during the first two days despite an adequate therapy for alcoholic weaning with hydratation, benzodiazepines and vitamins. A severe hypophosphatemia is diagnosed, associated with hypovitaminosis D, mild hypomagnesemia, mild hypokaliemia and a refeeding syndrome. 24 hours after the normalisation of his phosphatemia, the neurologic symptoms are adjusted. [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although delirium always has an organic aetiology, it remains a frequent cause of calling the liaison psychiatrist. Through a clinical case, we concentrate on the clinical description of the delirium and more specifically on one of its rare origins in a female anorectic patient : the refeeding syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Lifesaving treatment in patients with anorexia nervosa and compromised nutritional status is controversial. Enteral nutrition, via a nasogastric tube can be useful in this situation. The digestive tract can be used better than parenteral nutrition. Enteral nutrition can also be used in a situation with moderate malnutrition and stable body weight despite an adequate psychological treatment. In all cases, this treatment should be discussed and accepted with the patient. Polymeric standard solutions can be used, taking care of the level of protein which should not be too high. The start of enteral nutrition is progressive, in order to avoid the risk of Refeeding Syndrome. Vitamins and phosphorus should be added to the enteral nutrition during the first few days. Complications of treatment is not frequent with these patients and are presented. Enteral nutrition should be not too long and should be decreased in the same time that oral nutrition progressively increases. The results of literature show that, enteral nutrition does not deteriorate the psychological state of the patients and is found to be accepted more positively than forced feeding orally in the initial critical phases, and is less dangerous in terms of metabolic tolerance. For these reasons, enteral nutrition should be included in the armament of treatment of anorexia nervosa. [Copyright &y& Elsevier]

Abstract: Anorexia nervosa is a serious syndrome that can kill patients due to malnutrition complications by muscular weakness, especially cardiac and/or diaphragmatic failure, and infections. Clinical gravity criteria, linked to body mass index and visceral impairment symptoms must be known. Major biological gravity criteria are severe and symptomatic hypokaliemia, hypophosphoremia and hypoglycaemia. Renutrition must absolutely be careful to prevent the refeeding syndrome, the major risk of severe anorexia that can cause multivisceral organ failure. [Copyright &y& Elsevier]

Abstract: Children are especially threatened by malnutrition, because of the high protein-energy cost of growth. Any nutritional deficiency is the source of protein energy malnutrition, which compounds the problems of underlying disease. The protein-energy cost of catch-up growth is particularly high, and should lead to a rigorous adjustment of nutritional supply to prevent metabolic disorders associated with refeeding syndrome (directly related to the homeostatic change secondary to severe protein energy malnutrition). If the gastrointestinal tract can be used for refeeding, it should be used (oral or enteral nutrition). When the gastrointestinal tract is unable to meet the protein and energy requirements, parenteral nutrition is required. Catch-up growth may be achieved by using appropriate nutritional support. [Copyright &y& Elsevier]

Résumé Le syndrome de renutrition inapproprié (SRI) est une pathologie rare et grave avec des manifestations polyviscérales survenant chez des patients dénutris sévères. La prévention est la clé de la prise en charge. Bien que les troubles du rythme cardiaque secondaires aux désordres hydro électrolytiques soient le plus souvent décrits, nous rapportons le cas original d’un choc cardiogénique survenu au troisième jour de la renutrition chez une patiente de 32 ans. Refeeding syndrome (RS) is a rare and serious disease with multi-organ system failure occurring in severely malnourished patients. Prevention is the key to support. Although cardiac arrhythmias due to fluid and electrolyte disorders are often described, we report the original case of cardiogenic shock occurred in a third day refeeding of a 32-year-old patient. [ABSTRACT FROM AUTHOR]

Covid-19 infection is a potentially serious disease. Overweight, obesity, and diabetes are comorbidities frequently found in the severe form of the disease. Appropriate nutritional management of the patient is an integral part of care. We will discuss the renutrition of a 76-year-old, obese (BMI = 35kg/m 2 ), malnourished patient, according to the 2021 Haute Autorité de santé criteria, with Covid-19 infection, admitted to the intensive care unit at the Bordeaux University Hospital for an acute respiratory distress syndrome. Adaptation of nutritional intakes was achieved by clinical and biological monitoring. A refeeding syndrome was treated on the first day of hospitalization in the intensive care unit. After thiamine supplementation and when kalemia and phosphatemia have been normalized, renutrition was started. Parenteral nutrition as a complement to oral nutrition was used. Parenteral nutrition was well tolerated; recommended caloric and protein intakes were achieved by the fourth day of hospitalization. The clinical evolution was favorable. In conclusion, patients with Covid-19 infection should be considered malnourished when admitted to the intensive care unit. Macro and micronutrient intakes adapted to metabolically stressed patients are essential. Biological monitoring including monitoring of ionogram, phosphate, uremia, creatinine, liver function tests and blood glucose is essential in the nutritional management of patients with serious Covid-19 infection.

Refeeding syndrome (RS) is a rare but severe condition that is poorly understood, often under-diagnosed and can lead to death. It occurs within 5 days after refeeding in patients after prolonged fasting or in a context of undernutrition. As a consequence of the abrupt transition from catabolism to anabolism, RS is defined as a decrease in plasma levels of phosphorus, potassium and/or magnesium, whether or not associated with organ dysfunction resulting from a decrease in one of the electrolytes or a thiamine deficiency, after refeeding. The clinical symptoms are varied and non-specific and are related to hydro electrolyte disorders, sodium-hydroxide retention or failure of one or more organs. Patient management should be appropriate with regular clinical examination and careful biological monitoring, including hydro electrolyte monitoring. The correction of hydroelectrolytic disorders and systematic thiamine supplementation are essential during refeeding, that must be done carefully and very progressively, whatever its form (oral, enteral or parenteral). The severity of the refeeding syndrome indicates that its prevention and screening are the corners of its management in at-risk patients., (Copyright © 2020. Published by Elsevier Masson SAS.)

Patients with severe cases of COVID-19 are at high nutritional risk during their ICU stay. Prolonged immobilization associated with an exacerbated systemic inflammatory response is a major provider of ICU-acquired muscle weakness. Early enteral nutrition is recommended to gradually reach the energy target of 25 kcal/kg/day and protein target of 1.3 g/kg/day around D4. The occurrence of a Refeeding syndrome should be closely monitored. In case of feeding intolerance refractory to a prokinetic treatment, complementary or total parenteral nutrition is advised, favouring new generation mixed lipid emulsions (containing fish oil) and regular monitoring of triglyceridemia. Nutrition care of critically ill patients should be carried out with limited procedures that may pose a risk of contamination for the healthcare staff., (© 2020 Published by Elsevier Masson SAS.)

Patients suffering from alcohol use disorder (AUD) are at risk for malnutrition. The mechanisms are presented in this article. Nutrition disorders in the patient with AUD can include malnutrition, micronutrient deficiencies, overweight and obesity. They may contribute to tissue damage and to oncological and cognitive disorders encountered among patients with AUD. Refeeding syndrome can appear during the withdrawal period. A nutrition evaluation should be included in the evaluation of all patients with AUD., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.