Refeeding procedures after 43 days of total fasting

Refeeding syndrome encompasses fluid and electrolyte imbalances and metabol ic, intestinal, and cardiorespiratory derangements associated with apprecia ble morbidity and mortality. Although refeeding syndrome has been well docu mented 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 s trikers who refused food for 43 d. In this retrospective, observational stu dy, we assessed the safety and efficacy of the refeeding procedure and anal yzed the clinical and nutritional course of the cohort during both starvati on and refeeding, mainly on the basis of clinical as well as a few biochemi cal determinations. During starvation, average weight loss was about 18% an d, with the exception of occasional oral vitamins and electrolytes, the sub jects consumed only water. Available body-composition and biochemical profi les showed no clinically significant changes during starvation, but one-hal f of the group displayed spontaneous diarrhea at some rime before refeeding . Stepwise nutritional replenishment lasted for 9 d. after which all patien ts tolerated a full, unrestricted diet. Only one episode of diarrhea occurr ed 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 m icronutrient imbalances did not occur, nor was macronutrient intolerance de tected. 2) Despite some episodes of diarrhea, nutritional replenishment was not associated with significant enteral dysfunction. 3) There was some flu id retention, but this was mild. 4) Acute-phase markers were abnormally ele vated during the refeeding phase, without associated sepsis or inflammation . (C) Elsevier Science inc. 2001.