PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 103 | POJ_0097)

Submitted Abstracts

PENSA 2017 Congress

Submitted: July 13, 2017

Abstract ID = 67 | Classification: (4) - Disease specific nutrition issues

Title: Reviewing the need for higher sensitivity risk screening for Refeeding Syndrome among Elderlies: A Case Report

Author(s): Naheeda D. Mustofa, MD; Ma. Luisa A. Manlapaz MD; Keziah Manalo, RND; Sarah Santos, RND

Institution where study was conducted: The Medical City-South Luzon, Sta. Rosa City, Laguna, Philippines

Keywords: refeeding syndrome, elderly, Philippines

Background: Refeeding Syndrome (RFS) is identified to be the occurrence of electrolyte imbalances, particularly hypophosphatemia in rapidly fed patients with identified BMI <16 up to 18.5, weight loss of >10-15% over 3-6 months, with low nutritional intake for 5-10days by the British Academy for Parenteral and Enteral Nutrition (BAPEN). RFS remains to be recognized further in Asia especially for elderly patients.

Objectives: We report an incidence of Refeeding Syndrome.

Methods: Case report.

Case: We report an incidence of Refeeding Syndrome in a non-diabetic, non-hypertensive, wheelchair-borne 92-year old female patient who presented with anorexia only for 3 days with an average oral intake of 900-1200 kcal/day prior to loss of appetite. The patient was admitted for cellulitis on the upper right arm and urinary tract infection, weighed 45kg and had a BMI of 19.5. Upon admission, she was started on a 20kcal/kg BW standard polymeric formula tube feeding based on the average intake together with antibiotics and multivitamins. Baseline electrolytes were normal, with an upward trend on the 2nd day of admission and a sudden drop on the 5th day of Serum K (2.7mmol/L) and Phosphorus (1.3mg/dl) associated with drowsiness. Feeding was reduced to 50% of TCR for 5days, started on dicalcium phosphate+ Vit B complex (Glutaphos) tablet TID and K correction through IV. She also developed right-sided pleural effusion at 256ml on the 10th hospital day despite on controlled fluid and feeding delivery, which resolved on the 15th hospital day upon repeat chest ultrasound. Patient was sent home on the 17th hospital day, stable, with normal Serum K (4.2mmol/L), Na (140mmol/L), and Phosphorus (3.2mg/dl). Serum magnesium was normal throughout the admission. Patient is still on tube feeding upon follow-up on day 45, alert, coherent and able to tolerate sips of minimal foods per orem.

Conclusion: A stricter guideline on refeeding syndrome for elderly patients presenting even with short-term anorexia and normal BMI may be beneficial for safer delivery of clinical nutrition interventions.