Refeeding-Syndrom: Ein konsensusbasierter Algorithmus für stationäre Patienten

Zusammenfassung

Das Refeeding-Syndrom (RFS) ist ein oft übersehender, aber potenziell lebensbedrohlicher metabolischer Zustand. Es kann nach der Aufnahme einer Ernährungstherapie eines mangelernährten Patienten entstehen. Charakterisiert ist es durch Elektrolytstörungen (insbesondere Hypophosphatämie, Hypokaliämie und Hypomagnesiämie), ein Flüssigkeitsungleichgewicht sowie Salzretention und konsekutiv eingeschränkte Organfunktionen. Die Evidenzlage bezüglich des RFS ist dürftig. Kürzlich ist eine systematische Literaturreview zu den Risikofaktoren, diagnostischen Kriterien, präventiven und therapeutischen Maßnahmen zum RFS publiziert worden. Auf Basis dieser Übersichtsarbeit wurden von einem internationalen Expertengremium klinisch relevante Empfehlungen erarbeitet und ein Algorithmus für die Prävention, das Management und das Monitoring des RFS bei stationären Patienten entwickelt. Es werden spezifische Kriterien für die Diagnosestellung, die Risikostratifikation und praktische, konkrete Empfehlungen für das Management der Ernährungstherapie von Patienten jeder Risikokategorie vorgeschlagen. Zudem werden die schrittweise Implementierung der Energie- und Flüssigkeitszufuhr sowie eine Elektrolyt- und Vitaminsupplementierung bzw. -substitution und das detaillierte Vorgehen für das Monitoring aufgezeigt. Diese Empfehlungen beabsichtigen, das Management des RFS im klinischen Alltag zu optimieren und zu standardisieren. Der Fokus liegt auf klinisch relevanten Fragen bezüglich dem Management von stationären Risikopatienten. Qualitativ hochstehende Studien werden benötigt, um diese Empfehlungen zu evaluieren und zu bestätigen. In der vorliegenden Arbeit werden ebendiese Empfehlungen vorgestellt.

Abstract

The refeeding syndrome (RFS) is an often overlooked potential life-threatening metabolic condition. It can appear as a consequence of the refeeding of a catabolic malnourished patient. RFS is characterized by electrolyte disturbances (particularly hypophosphatemia, hypokalaemia and hypomagnesaemia) as well as by fluid dysbalance, salt retention and consecutive impaired organ function. The current evidence level for this topic is poor. A systematic literature review on risk factors, diagnostic criteria, preventive and therapeutic measures of the RFS was recently published. On that basis, an international expert group elaborated clinically relevant recommendations and developed an algorithm for the prevention, management and monitoring of the RFS in medical inpatients, which are explained in this paper. Specific criteria for the diagnosis, the risk stratification and practical suggestions for the management of nutritional therapy in patients of each risk category are proposed. The experts recommend a stepwise implementation of the energy and fluid supply as well as an electrolyte and vitamin supplementation respectively substitution. Moreover, a detailed approach of a close monitoring is demonstrated. These recommendations may help to optimize and standardize the management of at risk medical inpatients in daily practice. The focus is on daily clinical issues with medical inpatients. High quality studies will be needed to validate and further improve these recommendations.

Schlüsselwörter

Refeeding-Syndrom - Management - Therapie

Keywords

refeeding syndrome - management - therapy

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