Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia--the contribution of refeeding syndrome.
BACKGROUND
The refeeding syndrome (RS) is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, mainly hypophosphatemia, fluid retention and dysfunction of various organs and systems, which can result in significant morbidity and occasionally death.


OBJECTIVE
To examine the incidence of death cases and death causes following nasogastric tube (NGT) feeding initiation in frail elderly with particular reference to RS.


METHODS
Forty patients with feeding problems for at least 72 h before restarting of alimentation by NGT were included. Excluded were those in any critical clinical situation. Clinical parameters and nutritional assessment were recorded before and after refeeding. Blood samples were taken before, daily for the first 3 days and 1 week after refeeding initiation.


RESULTS
During the 1st week of refeeding, 9 patients (22.5%) died and within 1 month 10 more, summing to 47.5%. Most deaths were due to infectious causes [15 out of 19, (79%)]; some were due to no obvious reason [4 out of 19, (21%)]. Significant electrolyte changes were observed in the 2-3 days following refeeding. Significant were the decreases in phosphorus and elevations in potassium and lymphocytes (day 7). We found no correlations between the severity of decreases in levels of phosphorus and mortality.


CONCLUSIONS
Mortality after NGT feeding initiation was high, mainly due to infectious complications. However, in a considerable number of patients hypophosphatemia was noted, suggesting that RS could be a contributory factor of mortality. Since this is a treatable condition, more attention should be paid to detecting and coping with this problem.
Shmuel Harofe Geriatric Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Emilia
E
Lubart
Arthur
A
Leibovitz
Yosef
Y
Dror
Elena
E
Katz
Refael
R
Segal
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D017674:Hypophosphatemia / Q000209:etiology / Q000517:prevention & control; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D055677:Refeeding Syndrome / Q000209:etiology* / Q000401:mortality*; D013577:Syndrome; D013997:Time Factors; D014882:Water-Electrolyte Balance