Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review)

A.I. Yaroshetskiy1,2, V.D. Konanykhin1, S.O. Stepanova2, N.A. Rezepov2

1 Pirogov Russian National Research Medical University, Moscow

2 L.A. Vorokhobov Municipal Clinical Hospital No. 67, Moscow

For correspondence: Vasily D. Konanykhin, laboratory assistant of the Department of Anesthesiology and Critical Care of the Scientific Research Institute for Clinical Surgery at N.I. Pirogov Russian National Research Medical University; e-mail: v.konanykhin@ya.ru

For citation: Yaroshetskiy AI, Konanykhin VD, Stepanova SO, Rezepov NA. Hypophosphatemia and refeeding syndrome in the resumption of nutrition in critical care patients (review). Alexander Saltanov Intensive Care Herald. 2019;2:82–91.

DOI: 10.21320/1818-474X-2019-2-82-91


Refeeding syndrome is a life-threatening condition that occurs when nutrition is restarted in patients with initial malnutrition. For the first time refeeding syndrome was described more than 70 years ago but it still has not been studied enough. The pathophysiology of refeeding syndrome is based on severe electrolyte and metabolic disorders caused by the restoration of nutrition with an initial deficiency of phosphorus, potassium, magnesium which lead to organ failure. Hypophosphatemia is the main feature of the refeeding syndrome while in ICU patients there are many other causes of hypophosphatemia which complicates diagnostics. Most studies on refeeding syndrome have been conducted among patients with anorexia nervosa. In ICU refeeding hypophosphatemia occurs in about 34 % of cases but until recently all guidelines for the management of this condition have been extrapolated from the practice of treatment anorexia nervosa and were based on expert opinion. Several major studies have proven the effectiveness of a hypocaloric feeding during refeeding syndrome in critically ill patients recently.

This review is devoted to the problem of refeeding syndrome in patients with anorexia nervosa and critical care patients, differential diagnostics and treatment approaches for this condition.

Keywords: refeeding syndrome, hypophosphatemia, nutritional support, parenteral nutrition

Received: 03.03.2019


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Perioperative nutritional support. Russian Federation of anesthesiologists and reanimatologists guidelines

I.N. Leyderman, A.I. Gritsan, I.B. Zabolotskikh, S.V. Lomidze, V.A. Mazurok, I.V. Nekhaev, E.M. Nikolaenko, A.V. Nikolenko, I.V. Poliakov, A.V. Sytov, A.I. Yaroshetskiy

Russian Federation of Anesthesiologists and Reanimatologists

For correspondence: Leyderman Ilya Naumovich — Chair of Anesthesiology, Critical Care and Transfusiology, Ural State Medical University, Ekaterinburg; e-mail: inl230970@gmail.com

For citation: Leyderman IN, Gritsan AI, Zabolotskikh IB, Lomidze SV, Mazurok VA, Nekhaev IV, Nikolaenko EM, Nikolenko AV, Poliakov IV, Sytov AV, Yaroshetskiy AI. Perioperative nutritional support. Russian Federation of anesthesiologists and reanimatologists guidelines. Alexander Saltanov Intensive Care Herald. 2018;3:5–21.

DOI: 10.21320/1818-474X-2018-3-5-21


Malnutrition among surgical patients is rather common problem. The degree and severity of malnutrition after surgery significantly correlates with the length of stay in the intensive care unit and surgical hospital, rate of infectious complications development, unsatisfactory results of treatment and increased costs. The presented clinical recommendations clarifies key methods for the prevention of development, diagnosis and treatment of the protein-energy malnutrition (PEM) syndrome in the pre and postoperative period. The choice of methods for diagnosis and PEM correction during the perioperative period is based on studies evaluated from the endpoints of evidence-based medicine. In applications, key quality criteria for treatment, as well as algorithms of actions in the preoperative and postoperative period are presented.

Keywords: preoperative period, postoperative period, protein-energy malnutrition, nutritional status, parenteral nutrition, enteral nutrition, nutritional support

Received: 20.08.2018


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The Problem of Malnutrition in Surgical Intensive Care Unit

I.V. Polyakov1, I.N. Leiderman2, K.N. Zolotukhin1

1 Republican Clinical Hospital named after G.G. Kuvatov, Ufa

2 Ural State Medical University, Ekaterinburg

For correspondence: Leiderman Iliya Naumovich — Doctor of Medical Science, professor, department of aneshtesiology, reanimatology and transfusiology of Ural State MedicalUniversity, Ekaterinburg; e-mail: inl230970@gmail.com

For citation: Polyakov IV, Leiderman IN, Zolotukhin KN. The Problem of Malnutrition in Surgical Intensive Care Unit. Intensive Care Herald. 2017;1:56–66.


At the present stage of critical care medicine development early and optimal nutritional support is the most effective method of prevention and correction of disorders of protein and energy metabolism. In Russian and foreign literature structured data on the impact of new methods of early enteral and parenteral nutrition on the course of the critical illness of heterogeneous groups of patients were published during last 10–15 years. In this connection, it is advisable to conduct more detailed study of the features of violations of disorders of energy and protein metabolism, evaluation of the effectiveness of new methods of correction and prevention of malnutrition in patients general surgery ICU of a single hospital.

Keywords: malnutrition, nutritional support, enteral nutrition, parenteral nutrition 

Received: 18.12.2016


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Modern Approaches to Perioperative Nutritional Support in Oncology

A.E. Shestopalov

GBOU DPO «Russian Medical Academy of Postgraduate Education» The Ministry of Health of the Russian Federation, Moscow

For citation: Shestopalov AE. Modern Approaches to Perioperative Nutritional Support in Oncology. Intensive Care Herald. 2016;2:5–14.


Malnutrition in patients with cancer is the result of gross metabolic disorders, cachexia and anorexia associated with tumor necrosis factor. Metabolic disorders include disorders ofcarbohydrate, protein, lipid metabolism and enzymatic components that increase energy requirements and deficiency of essential nutrients. In addition, considerable importance in the formation of a nutrient deficiency is the local influence of the tumor — destructive processes, compression or destruction of surrounding tissue and organs. The special features of metabolic disorders and malnutrition in cancer patients should include immunosuppression, which is a negative prognostic factor for the outcome ofsurgical treatment.

Along with preoperative nutritional deficiency metabolic response to surgical trauma has significant effect on the postoperative course and results of surgical treatment. Catabolic type metabolism in combination with morphological and functional lesions of the gastrointestinal tract (intestinal distress syndrome) is characterized by the development of protein-energy malnutrition (PEM), nutritional status violation and impossibility of providing the body with nutrients naturally. In turn, malnutrition and active proteolysis contribute to slowing down regenerative processes, wound healing, cell differentiation and disorders of the immune system increasing the risk of infectious complications.

The current situation in recent years, the concept of nutritional support in surgical patients is intended to sinclude enteral and parenteral nutrition (glutamine, arginine, omega-3 fatty acids).

Keywords: nutritional support, cancer patients, protein-energy malnutrition

Received: 16.06.2016


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