title: Assessing the metabolic and clinical consequences of early enteral feeding in the malnourished patient.
abstract: BACKGROUND
  It is often thought that enteral feeding should be initiated slowly in those who are severely malnourished. This descriptive study examined the effect of an enteral feeding protocol on the typical metabolic consequences seen in refeeding syndrome.
  
  
  METHODS
  A retrospective chart review was conducted on 51 patients who had been placed on hospital-wide enteral feeding and electrolyte replacement protocols over a 9-month period to determine whether there were any negative clinical consequences to early feeding.
  
  
  RESULTS
  Goal feeding rate was achieved within 17.6 +/- 8.7 hours. Forty patients (80%) developed depletions in phosphate, magnesium, or potassium after initiation of enteral feeding, including 93% of those deemed "at risk" and 74% of those "not at risk." All patients received electrolyte replacement according to protocols, and no patients showed any negative clinical effect.
  
  
  CONCLUSIONS
  This study showed that malnourished patients at risk for refeeding syndrome can be fed early without observed negative clinical consequences. An electrolyte replacement protocol may be an effective means of minimizing the electrolyte imbalances associated with early feeding. It also demonstrated the significance of applying such protocols to all patients requiring enteral support, as current methods of assessing "risk"for refeeding syndrome may be inadequate.
authors.affiliation: Richmond Hospital, Richmond, British Columbia, Canada. mflesher@shaw.ca
authors.forename: Mary E
authors.initials: ME
authors.lastname: Flesher
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Archer
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Leslie
authors.forename: Robert A
authors.initials: RA
authors.lastname: McCollom
authors.forename: Grzegorz P
authors.initials: GP
authors.lastname: Martinka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004573:Electrolytes / Q000008:administration & dosage*; D004750:Enteral Nutrition / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009748:Nutrition Disorders / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control
chemical_list: D004573:Electrolytes