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4CPS-245 Prevention of refeeding syndrome in patients on parenteral nutrition: a review of appropriateness
  1. M Iglesias Rodrigo,
  2. C Sebastián Carrasco,
  3. C Sangrador Pelluz,
  4. N Meca Casasnovas,
  5. F Salazar González,
  6. B Tenas Rius,
  7. J Nicolás Picó
  1. Pharmaceutic, Hospitalary Pharmacy, Terrassa, Spain


Background and Importance Refeeding syndrome (RFS) is a metabolic disorder that can be triggered after nutritional replacement. This condition can be life-threatening, so early identification and prevention is important.

Aim and Objectives Describe a system of screening and nutritional support in patients at risk of RFS. Assess the degree of adequacy of initial parenteral nutrition (TPN) to published NICE guidelines.

Material and Methods Retrospective observational study including patients from January 2020 to September 2022 identified with RFS risk, according to NICE guidelines criteria, at the beginning of TPN.

Variables collected were: age, sex, weight, height, service, low/no intake in 5–10 days prior to starting TPN, type of RFS risk (high or extreme), kilocalories (Kcal) of TPN at baseline and at reaching total requirements, time to establishment of total kcal on TPN and development of RFS (decrease in serum levels of potassium, phosphate, magnesium in the first 72 hours).

Results 33 patients were included. The mean age was 59,6 years (SD: 15,5). 54,5% were men. The mean BMI was 20,2 (SD: 4,0). 33,3% were surgery patients; 27,3% onco-haematology; 24,2% digestive; 9.1% critical care; 6,1% others. 75,8% of the patients had low/no intake prior to the introduction of TPN. A total of 90,9% were at high risk of developing RFS. The mean kcal/kg of TPN at the start was 20,4 (SD: 3,7). In 63,6% of patients total kcals were instituted within 2 days, and in 36,4% within 3 days. 3 patients developed RFS, all at high risk, 2 of them being onco-haematological.

Conclusion and Relevance Most patients who developed RFS were onco-haematologic, a group at risk for RFS, and had little/no intake prior to the initiation of TPN.

In line with the recommendations established by NICE guidelines, the kcal/kg provided by TPN at baseline are higher than recommended (20.4 vs 10 kcal/kg). In addition, the total kcal were reached between 2–3 days, the recommendations being between 4–7 days. Only 9.1% of the patients developed RFS, so that future studies could consider a less restrictive caloric start in TPN than that proposed in the aforementioned guidelines.

The role of the pharmacist, together with the rest of the multidisciplinary team, has allowed early detection and prevention of developing RFS in 90.9% of the patients.

Conflict of Interest No conflict of interest.

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