Gut Liver.
2019 Sep;13(5):576-581. 10.5009/gnl18458.
Refeeding Syndrome as a Possible Cause of Very Early Mortality in Acute Pancreatitis
- Affiliations
-
- 1Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
- 2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 3Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea. jhcho9328@gmail.com
- KMID: 2458515
- DOI: http://doi.org/10.5009/gnl18458
Abstract
- BACKGROUND/AIMS
Refeeding syndrome (RFS) is a fatal clinical complication that can occur as a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourished patients. This study was conducted to determine the clinical implications of RFS in patients with acute pancreatitis (AP).
METHODS
Between 2006 and 2016, AP patients with very early mortality were retrospectively enrolled from three university hospitals.
RESULTS
Among 3,206 patients with AP, 44 patients died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to 92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33 hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones in five patients, and hypertriglyceridemia in two patients. Ranson score, bedside index for severity of AP, and acute physiology and chronic health evaluation-II were valuable for predicting very early mortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45]). RFS was diagnosed in nine patients who died of septic shock (n=5), cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS had significant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8 mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days was approximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritional support.
CONCLUSIONS
The findings of current study emphasize that clinicians should be aware of the possibility of RFS in malnourished AP patients with electrolyte imbalances.
