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Refeeding syndrome: multimodal monitoring and clinical manifestation of an internal severe neurotrauma
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.ORCID iD: 0000-0002-1313-0934
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2020 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614Article in journal (Refereed) Epub ahead of print
Abstract [en]

Refeeding syndrome (RFS) is a rare, potentially life-threatening, condition seen in malnourished patients starting refeeding. RFS may provoke seizures and acute encephalopathy and can be considered an internal severe neurotrauma in need of specific treatment. The objective was to describe course of disease, treatment and, for the first time, multimodal monitoring output in a comatose patient suffering RFS. After gastric-banding and severe weight loss, the patient initiated self-starving and was transferred to our intensive care unit (ICU) following rapid refeeding. At arrival, seizures, decrease in consciousness (GCS 7) and suspected acute encephalitis was presented. Serum albumin was 8 g/l. Intracranial pressure (ICP), invasive blood pressure and electrocardiography (ECG) were monitored. Pressure reactivity (PRx) and compliance (RAP) were calculated. The patient developed congestive heart failure, anuria and general oedema despite maximal neuro- and general ICU treatment. Global cerebral oedema and hypoperfusion areas with established ischemia were seen. ECG revealed massive cardiac arrhythmia and disturbed autonomic regulation. PRx indicated intact autoregulation (−0.06 ± 0.18, mean ± SD) and relatively normal compliance (RAP = 0.23 ± 0.13). After 15 days the clinical state was improved, and the patient returned to the primary hospital. RFS was associated with serious deviations in homeostasis, high ICP levels, ECG abnormalities, kidney and lung affections. It is of utmost importance to recognize this rare syndrome and to treat appropriately. Despite the severe clinical state, cerebral autoregulation and compensatory reserve were generally normal, questioning the applicability of indirect measurements such as PRx and RAP during neuro-intensive care treatment of RFS patients with cerebral engagement.

Place, publisher, year, edition, pages
2020.
Keywords [en]
Cerebral autoregulation, Compensatory reserve, Multimodal monitoring, Neurotrauma, Obesity surgery, Refeeding syndrome
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-170952DOI: 10.1007/s10877-020-00513-yISI: 000530248600001PubMedID: 32363496Scopus ID: 2-s2.0-85084220416OAI: oai:DiVA.org:umu-170952DiVA, id: diva2:1431100
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19

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Sundström, NinaBrorsson, CamillaWiklund, UrbanKoskinen, Lars-Owe D.
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