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Refeeding-Syndrom

Pathophysiologie, Risikofaktoren, Prophylaxe und Therapie

Refeeding syndrome

Pathophysiology, risk factors, prevention, and treatment

  • Schwerpunkt: Medizin für den ganzen Menschen
  • Published:
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Zusammenfassung

Das Refeeding-Syndrom ist eine potenziell lebensbedrohliche Komplikation, die zu Beginn einer Ernährungstherapie bei mangelernährten Patienten bzw. nach der Wiederaufnahme der Ernährung nach einer Fasten- oder Hungerperiode entstehen kann. Bei Kenntnis der Risikofaktoren und der Pathophysiologie kann der Entwicklung eines Refeeding-Syndroms wirksam vorgebeugt werden bzw. dieses bei frühzeitiger Erkennung wirksam behandelt werden. Die initiale Bestimmung des Thiaminspiegels und der Serumelektrolyte, inklusive Magnesium und Phosphat, sowie gegebenenfalls deren Supplementierung, ein langsamer Kostaufbau und die engmaschige Überwachung der Serumelektrolyte spielen dabei eine zentrale Rolle. Da das Refeeding-Syndrom wenig bekannt ist und die Symptomatik sehr vielgestaltig sein kann, wird diese Komplikation sehr häufig nicht erkannt, insbesondere vor dem Hintergrund von schwerer Erkrankung und Multimorbidität. Die vorliegende Übersicht soll den gegenwärtigen Wissensstand zusammenfassen und für die Bedeutung des Refeeding-Syndroms sensibilisieren.

Abstract

Refeeding syndrome is a life-threatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Refeeding syndrome can be effectively prevented and treated if its risk factors and pathophysiology are known. The initial measurement of thiamine level and serum electrolytes, including phosphate and magnesium, their supplementation if necessary, and a slow increase in nutritional intake along with close monitoring of serum electrolytes play an important role. Since refeeding syndrome is not well known and the symptoms can be extremely heterogeneous, this complication is poorly recognized, especially against the background of severe disease and multimorbidity. This overview aims to summarize the current knowledge and increase awareness about refeeding syndrome.

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Correspondence to R. Wirth.

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R. Wirth, R. Diekmann, G. Janssen, O. Fleiter, L. Fricke, A. Kreilkamp, M.K. Modreker, C. Marburger, S. Nels, M. Pourhassan, R. Schaefer, H.-P. Willschrei und D. Volkert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C.C. Sieber, Nürnberg

Der vorliegende Beitrag ist eine aktualisierte und gekürzte Version des Beitrags Refeeding-Syndrom bei geriatrischen Patienten. Z Gerontol Geriatr. 2018; 51(1):34–40. https://doi.org/10.1007/s00391-016-1160-8.

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Wirth, R., Diekmann, R., Janssen, G. et al. Refeeding-Syndrom. Internist 59, 326–333 (2018). https://doi.org/10.1007/s00108-018-0399-0

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  • DOI: https://doi.org/10.1007/s00108-018-0399-0

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