Faintuch J, Soriano F G, Ladeira J P, Janiszewski M, Velasco I T, Gama-Rodrigues J J
Nutrition Group and Department of Emergency Medicine, Hospital das Clinicas, São Paulo, Brazil.
Nutrition. 2001 Feb;17(2):100-4. doi: 10.1016/s0899-9007(00)00510-4.
Refeeding syndrome encompasses fluid and electrolyte imbalances and metabolic, intestinal, and cardiorespiratory derangements associated with appreciable morbidity and mortality. Although refeeding syndrome has been well documented in concentration-camp subjects, and more recently during parenteral therapy of critically ill patients, little is known about the importance of refeeding syndrome during recovery from a hunger strike. Thus, we studied the response to a four-step dietary replenishment routine in eight hunger strikers who refused food for 43 d. In this retrospective, observational study, we assessed the safety and efficacy of the refeeding procedure and analyzed the clinical and nutritional course of the cohort during both starvation and refeeding, mainly on the basis of clinical as well as a few biochemical determinations. During starvation, average weight loss was about 18% and, with the exception of occasional oral vitamins and electrolytes, the subjects consumed only water. Available body-composition and biochemical profiles showed no clinically significant changes during starvation, but one-half of the group displayed spontaneous diarrhea at some time before refeeding. Stepwise nutritional replenishment lasted for 9 d, after which all patients tolerated a full, unrestricted diet. Only one episode of diarrhea occurred during this phase, and both clinical and biochemical indexes confirmed a favorable clinical course, without any manifestation of refeeding syndrome. In conclusion, we observed the following: 1) Hypophosphatemia and other micronutrient imbalances did not occur, nor was macronutrient intolerance detected. 2) Despite some episodes of diarrhea, nutritional replenishment was not associated with significant enteral dysfunction. 3) There was some fluid retention, but this was mild. 4) Acute-phase markers were abnormally elevated during the refeeding phase, without associated sepsis or inflammation.
再喂养综合征包括与明显的发病率和死亡率相关的液体和电解质失衡以及代谢、肠道和心肺功能紊乱。尽管再喂养综合征在集中营幸存者中已有充分记载，且最近在重症患者的肠外治疗期间也有相关报道，但对于绝食恢复过程中再喂养综合征的重要性却知之甚少。因此，我们研究了8名绝食43天的绝食者对四步饮食补充程序的反应。在这项回顾性观察研究中，我们评估了再喂养程序的安全性和有效性，并主要基于临床及一些生化测定分析了该队列在饥饿和再喂养期间的临床和营养过程。在饥饿期间，平均体重减轻约18%，除偶尔口服维生素和电解质外，受试者仅饮水。可用的身体成分和生化指标在饥饿期间未显示出临床显著变化，但该组中有一半的人在再喂养前的某个时间出现了自发性腹泻。逐步营养补充持续了9天，之后所有患者都能耐受完全不受限制的饮食。在此阶段仅发生了一次腹泻，临床和生化指标均证实临床过程良好，未出现任何再喂养综合征的表现。总之，我们观察到以下几点：1）未发生低磷血症和其他微量营养素失衡，也未检测到常量营养素不耐受。2）尽管有一些腹泻发作，但营养补充与明显的肠功能障碍无关。3）有一些液体潴留，但程度较轻。4）再喂养阶段急性期标志物异常升高，但无相关的败血症或炎症。
