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VERIFIED CONTENTAuthor: Krzysztof Bialazite

Food shock syndrome (refeeding syndrome) is a condition that occurs in long-term malnourished people. Food shock syndrome causes serious electrolyte disturbances that can be life-threatening. Find out what causes the food shock syndrome, what diseases increase the risk of its occurrence, how it manifests itself and what is the prevention and treatment of food shock syndrome.

Food shock syndromewas first observed during the war in prisoners released from concentration camps. When proper nutrition was commenced after a prolonged period of fasting, many of them suddenly deteriorated. This paradoxical reaction of the body was called food shock syndrome. Many patients had the syndrome fatal.

Though the war is long over, food shock syndrome is still common. Hospitalized, chronically ill patients who, for various reasons, were in a state of malnutrition for a long time, are particularly vulnerable to its occurrence. Why suddenly starting proper nutrition has such dire consequences?

Food shock syndrome - causes

Food shock syndrome is caused by metabolic changes that occur in the body during starvation. Under normal circumstances, our body's main fuel is glucose. With prolonged starvation, glucose stores are depleted quickly. The body "switches over" to other sources of energy: fats and proteins.

Metabolism slows down significantly, all organs are operating in energy-saving mode. The main metabolic processes are the burning of proteins and fats, the pathways related to the use of glucose remain inactive.

What happens when you restart high-calorie, high-glucose nutrition? The body is unable to quickly adapt to the new situation and, as a result, it comes to food shock.

Rapid hormonal changes occur - large amounts of insulin are ejected suddenly. The cells begin to take up the glucose delivered to them intensively. Switching tissues to other metabolic pathways causes a rapid increase in the demand for some components (mainlyphosphates, magnesium, potassium and thiamine). These substances are necessary to use glucose as your main fuel.

Unfortunately, their rapid consumption leads to a sudden disturbance of the electrolyte balance. There is hypophosphatemia, hypomagnesaemia and hypokalemia (deficiency of phosphates, magnesium and potassium).

Vitamin deficiencies lead to muscle damage. Food shock syndrome also affects the work of the kidneys, which begin to conserve sodium and water. This is how puffiness develops.

Food shock syndrome - risk factors

Food shock syndrome is a life-threatening complication. For this condition, "prevention is better than cure" is true. Effective prevention of food shock syndrome requires, first of all, the identification of patients who are particularly at risk of developing it. They mainly include people who, for various reasons, were long-term malnourished.

Food shock risk factors include:

  • chronic hospitalization with the use of parenteral nutrition (patients after surgery, treated in intensive care units),
  • long-term lack of food consumption (fasting, long-term alcoholism),
  • sudden weight loss (>15% in six months),
  • chronic diseases leading to the destruction of the organism (neoplastic diseases, severe infections),
  • significant reduction in calorific value of consumed meals (e.g. in anorexia nervosa),
  • bariatric surgeries followed by a sudden drop in food intake,
  • diseases of the gastrointestinal tract that interfere with the absorption of food (inflammatory bowel diseases, celiac disease),
  • old age and fragility syndrome,
  • abuse of diuretics.

Food shock syndrome - symptoms

Symptoms of Food Shock Syndrome most often develop within the first 3-5 days of incorporating more food. Large fluctuations in the levels of electrolytes in the blood can disrupt the work of many organs. The first to appear most often:

  • involuntary muscle contractions,
  • trembling limbs
  • and feeling of numbness (also known as paraesthesia).

Then it is joined by weakness and a general deterioration in well-being. Kidney disorders cause the swelling to increase.

An organ that is particularly sensitive to changes in electrolyte levels is the heart muscle. Various heart disorders may appear in the food shock syndrome:

  • arrhythmias,
  • shrinkage reduction,
  • blocksconduction,
  • and in extreme cases, heart failure.

Muscle damage can also affect the respiratory muscles, leading to respiratory problems. Electrolyte disturbances can cause haemolysis, which is the breakdown of red blood cells. This is how anemia (anemia) develops.

Food shock syndrome - complications

Food shock syndrome is a life-threatening condition. Complications of the food shock syndrome involve organs, the functioning of which is essential for survival.

Within the nervous system, food shock syndrome leads to increasing disturbances of consciousness. Additionally, convulsions and hallucinations may appear, and in extreme cases, a coma develops.

The progressive weakening of the respiratory muscles causes the so-called respiratory depression, which in extreme cases causes complete respiratory arrest. Breakdown of muscle cells results in the release of a large amount of proteins into the bloodstream, which puts a heavy burden on the kidneys. Along with electrolyte disturbances, this condition can trigger acute kidney failure.

Heart abnormalities are a frequent cause of death in food shock syndrome. In the course of the syndrome, life-threatening arrhythmias as well as acute myocardial failure may occur. As a consequence, circulatory and respiratory failure develops, which can cause irreversible organ damage and death.

Food shock syndrome may develop a specific complication resulting from a deficiency of vitamin B1 (thiamine). Deficiency of this vitamin causes acute changes in the brain, which may result in the so-called Wernicke's encephalopathy or Korsakoff's amnesia. Wernicke's encephalopathy is a group of neurological symptoms that most often develops in alcoholics for many years.

Chronic alcoholism, like food shock syndrome, leads to significant vitamin B1 deficiencies. Symptoms of brain damage include:

  • nystagmus,
  • disturbance of consciousness,
  • motor incoherence,
  • mental disorders
  • and gait disturbance.

Korsakoff's amnesia may develop with Wernicke's syndrome. It is a special type of memory impairment, where fresh memory is significantly impaired. Patients with Korsakoff's syndrome have numerous memory gaps which they fill with colorful, unreal stories (the so-called confabulations).

Interestingly, in Korsakov's amnesia, other mental activities remain relatively intact. The memory of events from the distant future remains preserved.

Food shock syndrome -prophylaxis

The prevention of food shock syndrome should begin before the introduction of nutrition. At the very beginning, it is necessary to ensure proper hydration of the patient, and to replace the deficiencies of electrolytes. The patient should also receive a drip containing vitamins (especially vitamin B1) and trace elements.

How should I introduce larger amounts of food in malnourished people to avoid food shock syndrome? First of all, it should be done gradually. In the first days after starting nutrition, the number of calories introduced into the daily diet should be limited. At the beginning, you should consume a maximum of 30-50% of the daily energy requirement.

If the body tolerates food well and the results of laboratory tests are normal, you can gradually increase the amount of food consumed. The full caloric requirement should be achieved 4-7 days after starting nutrition.

Food shock syndrome - treatment

What is the management of a patient who develops food shock syndrome? The first step is to stop feeding immediately. The sooner the symptoms of the syndrome are recognized, the greater the chance of a quick intervention and improvement of the patient's condition. For this reason, every person at risk of food shock syndrome should be fed under the constant supervision of medical personnel.

If it is necessary to stop feeding, you should strive to balance the water and electrolyte balance (supplementing the levels of phosphorus, potassium and magnesium).

Patients at risk of food shock syndrome require daily monitoring of glucose, electrolytes and kidney function markers. If edema develops, fluid and sodium intake should be restricted.

If the diagnosis of food shock syndrome is delayed, complications may develop.

In this case, the patient requires constant monitoring of vital functions - blood pressure, heart rate and respiration. If life-threatening disorders occur (severe arrhythmias, acute renal failure), hospitalization in the intensive care unit may be necessary.

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Category:

Gastrology