Mortality after Nasogastric Tube Feeding Initiation in Long-Term Care Elderly with Oropharyngeal Dysphagia – The Contribution of Refeeding Syndrome

TLDR

Refeeding syndrome is an underappreciated, clinically important condition marked by acute electrolyte disturbances, fluid retention, and organ dysfunction that can cause significant morbidity and death. The study aimed to assess the incidence and causes of death after initiating nasogastric tube feeding in frail elderly, focusing on refeeding syndrome. Forty frail elderly patients with prolonged feeding problems were monitored; clinical parameters, nutritional assessments, and serial blood samples were collected before and during the first week of nasogastric tube refeeding. During the first week of refeeding, 22.5 % of patients died and 47.5 % died within a month, mainly from infections; significant electrolyte shifts, especially hypophosphatemia, were observed but did not correlate with mortality, indicating that refeeding syndrome may contribute to death and warrants early detection and management.

Abstract

The refeeding syndrome (RS) is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, mainly hypophosphatemia, fluid retention and dysfunction of various organs and systems, which can result in significant morbidity and occasionally death.To examine the incidence of death cases and death causes following nasogastric tube (NGT) feeding initiation in frail elderly with particular reference to RS.Forty patients with feeding problems for at least 72 h before restarting of alimentation by NGT were included. Excluded were those in any critical clinical situation. Clinical parameters and nutritional assessment were recorded before and after refeeding. Blood samples were taken before, daily for the first 3 days and 1 week after refeeding initiation.During the 1st week of refeeding, 9 patients (22.5%) died and within 1 month 10 more, summing to 47.5%. Most deaths were due to infectious causes [15 out of 19, (79%)]; some were due to no obvious reason [4 out of 19, (21%)]. Significant electrolyte changes were observed in the 2-3 days following refeeding. Significant were the decreases in phosphorus and elevations in potassium and lymphocytes (day 7). We found no correlations between the severity of decreases in levels of phosphorus and mortality.Mortality after NGT feeding initiation was high, mainly due to infectious complications. However, in a considerable number of patients hypophosphatemia was noted, suggesting that RS could be a contributory factor of mortality. Since this is a treatable condition, more attention should be paid to detecting and coping with this problem.