ASPEN Consensus Recommendations for Refeeding Syndrome.
magnesium; potassium; consensus; phosphorus; nutrition assessment; nutrition support; refeeding syndrome
INTRODUCTION: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. METHODS: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. FINDINGS/RECOMMENDATIONS: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. CONCLUSIONS: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
da Silva Joshua S V; Seres David S; Sabino Kim; Adams Stephen C; Berdahl Gideon J; Citty Sandra Wolfe; Cober M Petrea; Evans David C; Greaves June R; Gura Kathleen M; Michalski Austin; Plogsted Stephen; Sacks Gordon S; Tucker Anne M; Worthington Patricia; Walker Renee N; Ayers Phil
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
2020
2020-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/ncp.10474" target="_blank" rel="noreferrer noopener">10.1002/ncp.10474</a>
Magnesium disorders: what to do when homeostasis goes awry.
Adult; Female; Male; Aged; Outpatients; Middle Age; Diagnosis; Laboratory; Magnesium; Hypermagnesemia; Hypomagnesemia; Hypermagnesemia – Diagnosis; Hypermagnesemia – Drug Therapy; Hypermagnesemia – Etiology; Hypomagnesemia – Diagnosis; Hypomagnesemia – Drug Therapy; Hypomagnesemia – Etiology; Magnesium – Analysis; Magnesium Sulfate – Administration and Dosage
Hypomagnesemia may be caused by renal losses (often related to drugs or diabetes), inadequate intake or inadequate intestinal absorption. Manifestations may include arrhythmias, particularly during myocardial ischemia or with digitalis use, and such neurologic findings tremors, seizures, and eventually coma. Measure magnesium levels in critically ill patients, those with diabetes or alcoholism, and those taking drugs associated with magnesium loss. Magnesium deficiency often coexists with hypokalemia and hypocalcemia: to correct the latter abnormalities, replete the magnesium deficit first. Base your decision to replace the magnesium orally or parenterally on symptom severity, rather than on absolute serum levels. Magnesium excess may lead to cardiac arrest, with symptoms resembling hyperkalemia. Treat as you would for hyperkalemia, with IV calcium gluconate, insulin, and dextrose.
Trehan S; Rutecki G W; Whittier F C
Consultant (00107069)
1996
1996-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Promoting bone health in children and adolescents following solid organ transplantation.
bisphosphonates; bone; calcium; magnesium; metabolic bone disease; phosphorous; physical activity; solid organ transplant; vitamin D
Solid organ transplantation in children and adolescents provides many benefits through improving critical organ function, including better growth, development, cardiovascular status, and quality of life. Unfortunately, bone status may be adversely affected even when overall status is improving, due to issues with pre-existing bone disease as well as medications and nutritional challenges inherent post-transplantation. For all children and adolescents, bone status entering adulthood is a critical determinant of bone health through adulthood. The overall health and bone status of transplant recipients benefits from attention to regular physical activity, good nutrition, adequate calcium, phosphorous, magnesium and vitamin D intake and avoidance/minimization of soda, extra sodium, and obesity. Many immunosuppressive agents, especially glucocorticoids, can adversely affect bone function and development. Minimizing exposure to "bone-toxic" medications is an important part of promoting bone health in children post-transplantation. Existing guidelines detail how regular monitoring of bone status and biochemical markers can help detect bone abnormalities early and facilitate valuable bone-directed interventions. Attention to calcium and vitamin D supplementation, as well as tapering and withdrawing glucocorticoids as early as possible after transplant, can provide best bone outcomes for these children. Dual-energy X-ray absorptiometry can be useful to detect abnormal bone mass and fracture risk in this population and newer bone assessment methods are being evaluated in children at risk for poor bone outcomes. Newer bone therapies being explored in adults with transplants, particularly bisphosphonates and the RANKL inhibitor denosumab, may offer promise for children with low bone mass post-transplantation.
Kusumi K; Shaikhkhalil A; Patel HP; Mahan John D
Pediatric Transplantation
2020
2020-12-19
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/petr.13940" target="_blank" rel="noreferrer noopener">10.1111/petr.13940</a>