Di Caro, S

Fragkos, KC

Mehta, SJ

Rahman, F

English

UCL Discovery

1  Response to Letter re: Refeeding Syndrome in Adults Receiving Total Parenteral Nutrition: An Audit of Practice at a Tertiary UK Centre  Konstantinos C. Fragkos,1 Simona Di Caro,1 Shameer J. Mehta,1 Farooq Rahman1 1 Intestinal Failure Service, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom  Correspondence to: Dr Farooq Rahman Intestinal Failure Service, Department of Gastroenterology University College London Hospitals NHS Foundation Trust 250 Euston Road, London NW1 2PG, United Kingdom e-mail: farooq.rahman@nhs.net  Tel. +44 (0) 20344 79311, Fax: +44 (0) 20344 79217   Dear Editor,  We thank Wong and Lew [1] for their insightful comments. Refeeding syndrome (RFS) is a condition where definitions are highly heterogeneous among studies with some studies relying only on electrolyte disturbances with different cut-offs, and others also integrating clinical parameters into the definition [2]. These varying cut-offs alongside varying definitions produce an heterogeneous incidence of RFS [3]. Hypophosphatemia has been commonly used for defining RFS, which is arguably a broader syndrome that includes electrolyte abnormalities in addition to clinical symptoms [2].  In our paper [4], we explored hypophosphatemia (with cut-offs from Ahmed et al. [5]), alongside other electrolyte abnormalities, in low and high risk RFS syndrome patients receiving total parenteral nutrition, as defined by the National Institute for Health and Care Excellence guidelines [6]. Hypophosphatemia was not used as the sole defining criterion for RFS.  According to the definition suggested by Wong and Lew [1] of having serum phosphate level reduced by more than 0.16 mmol/L to below 0.65 mmol/L after initiating nutrition support, six patients (7.5%) experienced RFS by 72 hours and ten patients (12.5%) experienced RFS by 168 hours. When examining hypophosphatemia with the cut-offs suggested by Wong and Lew [1], distribution is not very dissimilar to the classification we followed (Table 1), with the new hypophosphatemia incidence being 20.0%, which is expected by a decreased lower normal cut-off of 0.71 mmol/L compared to our 0.85 mmol/L. Finally, the complications suggested by Wong and Lew [1] were not analysed as part of the present study. The present study examined abnormalities in terms of metabolic measurements and not clinical signs.    Table 1. Phosphate level distribution with cut-offs suggested by Wong and Lew [1].  Low risk RFS (n=20) High risk RFS (n=60) Total (n=80) Phosphate plasma levels    Normal/High (> 0.71 mmol/L) 20 (100.0%) 44 (73.3%) 64 (80.0%) Hypophosphatemia 0 (0.0%) 16 (26.7%) 16 (20.0%) Mild (0.55-0.71 mmol/L) 0 (0.0%) 9 (15.0%) 9 (11.3%) Moderate (0.32-0.54 mmol/L) 0 (0.0%) 6 (10.0%) 6 (7.5%) Severe (< 0.32 mmol/L) 0 (0.0%) 1 (1.7%) 1 (1.2%)    2  References   [1] Wong GJY, Lew CCH. Letter to editor re: Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre. Clin Nutr. 2018, doi:10.1016/j.clnu.2018.08.011. [2] Friedli N, Stanga Z, Sobotka L, Culkin A, Kondrup J, Laviano A, et al. Revisiting the refeeding syndrome: Results of a systematic review. Nutrition. 2017;35:151-60, doi:10.1016/j.nut.2016.05.016. [3] Glendenning P, Bell DA, Clifton-Bligh RJ. Investigating hypophosphataemia. BMJ. 2014;348:g3172, doi:10.1136/bmj.g3172. [4] Pantoja F, Fragkos KC, Patel PS, Keane N, Samaan MA, Barnova I, et al. Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre. Clin Nutr. 2018, doi:10.1016/j.clnu.2018.06.967. [5] Ahmed S, Travis J, Mehanna H. Re-feeding syndrome in head and neck--prevention and management. Oral Oncol. 2011;47:792-6, doi:10.1016/j.oraloncology.2010.06.009. [6] National Institute for Clinical Excellence GBN. Nutrition Support for Adults. Clinical Guideline CG32. 2006. p. 1–176.  

Response to Letter re: Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

https://discovery.ucl.ac.uk/10129791/1/Fragkosletter_2021%29ucl%20discovery.pdf

Response to Letter re: Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

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