title: Management of patients during hunger strike and refeeding phase.
abstract: OBJECTIVE
  Hunger strikers resuming nutritional intake may develop a life-threatening refeeding syndrome (RFS). Consequently, hunger strikers represent a core challenge for the medical staff. The objective of the study was to test the effectiveness and safety of evidence-based recommendations for prevention and management of RFS during the refeeding phase.
  
  
  METHODS
  This was a retrospective, observational data analysis of 37 consecutive, unselected cases of prisoners on a hunger strike during a 5-y period. The sample consisted of 37 cases representing 33 individual patients.
  
  
  RESULTS
  In seven cases (18.9%), the hunger strike was continued during the hospital stay, in 16 episodes (43.2%) cessation of the hunger strike occurred immediately after admission to the security ward, and in 14 episodes (37.9%) during hospital stay. In the refeed cases (n = 30), nutritional replenishment occurred orally, and in 25 (83.3%) micronutrients substitutions were made based on the recommendations. The gradual refeeding with fluid restriction occurred over 10 d. Uncomplicated dyselectrolytemia was documented in 12 cases (40%) within the refeeding phase. One case (3.3%) presented bilateral ankle edemas as a clinical manifestation of moderate RFS. Intensive medical treatment was not necessary and none of the patients died. Seven episodes of continued hunger strike were observed during the entire hospital stay without medical complications.
  
  
  CONCLUSIONS
  Our data suggested that seriousness and rate of medical complications during the refeeding phase can be kept at a minimum in a hunger strike population. This study supported use of recommendations to optimize risk management and to improve treatment quality and patient safety in this vulnerable population.
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Eichelberger
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: M L
authors.initials: ML
authors.lastname: Joray
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Perrig
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Bodmer
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: zeno.stanga@insel.ch.
authors.forename: Z
authors.initials: Z
authors.lastname: Stanga
mesh_terms: D000328:Adult; D004487:Edema / Q000209:etiology; D005215:Fasting; D005260:Female; D006760:Hospitalization; D006801:Humans; D006815:Hunger; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D011329:Prisoners; D055677:Refeeding Syndrome / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D013217:Starvation / Q000628:therapy*; D013317:Strikes, Employee; D014883:Water-Electrolyte Imbalance / Q000209:etiology
chemical_list: D018977:Micronutrients
keywords: Hunger strike; Refeeding; Refeeding syndrome; Starving