Refeeding syndrome in small ruminants receiving parenteral nutrition
Abstract Background Small ruminants presented to tertiary care facilities commonly suffer from severe protein‐calorie malnutrition. Some of these patients require parenteral nutrition (PN; amino acids and dextrose with or without lipids) during hospitalization. Refeeding syndrome, a potentially fata...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Journal of Veterinary Internal Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jvim.15840 |
| _version_ | 1819022952223473664 |
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| author | Daniela Luethy Darko Stefanovski Raymond W. Sweeney |
| author_facet | Daniela Luethy Darko Stefanovski Raymond W. Sweeney |
| author_sort | Daniela Luethy |
| collection | DOAJ |
| description | Abstract Background Small ruminants presented to tertiary care facilities commonly suffer from severe protein‐calorie malnutrition. Some of these patients require parenteral nutrition (PN; amino acids and dextrose with or without lipids) during hospitalization. Refeeding syndrome, a potentially fatal shift of electrolytes seen in malnourished patients during refeeding, may occur. Objective (a) To report the prevalence of refeeding syndrome in small ruminants receiving PN and (b) to determine risk factors for the development of refeeding syndrome. Animals Hospitalized small ruminants (n = 20) that received PN from 2010 to 2018 and that had serial (≥2) monitoring of serum electrolyte concentrations after initiation of PN. Methods Retrospective case series. Refeeding syndrome was defined as the presence of at least 2 of the following electrolyte abnormalities after initiation of PN: hypophosphatemia, hypokalemia, hypomagnesemia, or some combination of these. Data was analyzed using Fisher's exact test, followed by univariate logistic regression. Results Eleven of 20 (55%) animals met the definition of refeeding syndrome. Mean minimum serum phosphorus concentration in animals with refeeding syndrome was 1.96 ± 0.69 mg/dL (reference range, 4.2‐7.6 mg/dL). Eleven of 20 animals survived to discharge. Survival rate did not differ significantly between refeeding cases (4/11, 36.3%) and nonrefeeding cases (7/9, 77.8%; P = .09). Mean serum phosphorus concentration was significantly lower in nonsurvivors than in survivors (1.88 ± 0.10 mg/dL vs 4.32 ± 0.70 mg/dL, P = .006). Conclusions and Clinical Importance We report the prevalence of refeeding syndrome in small ruminants receiving PN. Clinicians should anticipate refeeding syndrome after initiation of PN and consider pre‐emptive supplementation with phosphorus, potassium, magnesium, or some combination of these. |
| first_indexed | 2024-12-21T04:31:10Z |
| format | Article |
| id | doaj.art-7bacf14ceb114bc4a5c0a7126978ef93 |
| institution | Directory Open Access Journal |
| issn | 0891-6640 1939-1676 |
| language | English |
| last_indexed | 2024-12-21T04:31:10Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Veterinary Internal Medicine |
| spelling | doaj.art-7bacf14ceb114bc4a5c0a7126978ef932022-12-21T19:15:56ZengWileyJournal of Veterinary Internal Medicine0891-66401939-16762020-07-013441674167910.1111/jvim.15840Refeeding syndrome in small ruminants receiving parenteral nutritionDaniela Luethy0Darko Stefanovski1Raymond W. Sweeney2Department of Clinical Studies‐New Bolton Center (Luethy, Stefanovski, Sweeney), School of Veterinary Medicine University of Pennsylvania Kennett Square Pennsylvania USADepartment of Clinical Studies‐New Bolton Center (Luethy, Stefanovski, Sweeney), School of Veterinary Medicine University of Pennsylvania Kennett Square Pennsylvania USADepartment of Clinical Studies‐New Bolton Center (Luethy, Stefanovski, Sweeney), School of Veterinary Medicine University of Pennsylvania Kennett Square Pennsylvania USAAbstract Background Small ruminants presented to tertiary care facilities commonly suffer from severe protein‐calorie malnutrition. Some of these patients require parenteral nutrition (PN; amino acids and dextrose with or without lipids) during hospitalization. Refeeding syndrome, a potentially fatal shift of electrolytes seen in malnourished patients during refeeding, may occur. Objective (a) To report the prevalence of refeeding syndrome in small ruminants receiving PN and (b) to determine risk factors for the development of refeeding syndrome. Animals Hospitalized small ruminants (n = 20) that received PN from 2010 to 2018 and that had serial (≥2) monitoring of serum electrolyte concentrations after initiation of PN. Methods Retrospective case series. Refeeding syndrome was defined as the presence of at least 2 of the following electrolyte abnormalities after initiation of PN: hypophosphatemia, hypokalemia, hypomagnesemia, or some combination of these. Data was analyzed using Fisher's exact test, followed by univariate logistic regression. Results Eleven of 20 (55%) animals met the definition of refeeding syndrome. Mean minimum serum phosphorus concentration in animals with refeeding syndrome was 1.96 ± 0.69 mg/dL (reference range, 4.2‐7.6 mg/dL). Eleven of 20 animals survived to discharge. Survival rate did not differ significantly between refeeding cases (4/11, 36.3%) and nonrefeeding cases (7/9, 77.8%; P = .09). Mean serum phosphorus concentration was significantly lower in nonsurvivors than in survivors (1.88 ± 0.10 mg/dL vs 4.32 ± 0.70 mg/dL, P = .006). Conclusions and Clinical Importance We report the prevalence of refeeding syndrome in small ruminants receiving PN. Clinicians should anticipate refeeding syndrome after initiation of PN and consider pre‐emptive supplementation with phosphorus, potassium, magnesium, or some combination of these.https://doi.org/10.1111/jvim.15840hypophosphatemiahypokalemiahypomagnesemiamalnutrition |
| spellingShingle | Daniela Luethy Darko Stefanovski Raymond W. Sweeney Refeeding syndrome in small ruminants receiving parenteral nutrition Journal of Veterinary Internal Medicine hypophosphatemia hypokalemia hypomagnesemia malnutrition |
| title | Refeeding syndrome in small ruminants receiving parenteral nutrition |
| title_full | Refeeding syndrome in small ruminants receiving parenteral nutrition |
| title_fullStr | Refeeding syndrome in small ruminants receiving parenteral nutrition |
| title_full_unstemmed | Refeeding syndrome in small ruminants receiving parenteral nutrition |
| title_short | Refeeding syndrome in small ruminants receiving parenteral nutrition |
| title_sort | refeeding syndrome in small ruminants receiving parenteral nutrition |
| topic | hypophosphatemia hypokalemia hypomagnesemia malnutrition |
| url | https://doi.org/10.1111/jvim.15840 |
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