Released Date: March 1, 2022
President’s Welcome
Happy New Year! I want to thank all the GASPEN members for your continuous support through volunteering in our committees and participating in our educational programs and annual conference. Although we find ourselves amid yet another COVID-19 surge at the start of 2022, as a chapter, we remain optimistic and will pull together to make it a better year than 2021.
To recap, we had a fantastic year at GASPEN in 2021! We co-hosted a meeting with Southeast Region Chapter - Society of Critical Care Medicine, collaborated with Children’s Healthcare of Atlanta (CHOA) to provide monthly nutrition support WebEx events, and hosted our annual conference virtually in August. Additionally, we launched www.GASPEN.org, where all GASPEN related information such as Newsletters, recorded presentations from our past events, upcoming events, etc. Don’t forget to bookmark us!
For 2022, the GASPEN board has already started to plan for our annual conference (virtual versus in-person; tentatively August 2022). GASPEN board members have reviewed the post-conference survey and our Survey Monkey results to narrow down the presentation topics. Stay tuned for more details. We will continue our collaboration with CHOA to provide nutrition support professional development WebEx events which cover both pediatric and adult nutrition topics. There are 14 presentations scheduled for 2022. All the WebEx event details are now available on our website, www.GASPEN.org/events.
\We are also pleased to announce that GASPEN elections for Treasurer-Secretary and President-elect will be held this year. Additional information and deadlines can be found in this newsletter. We would also like to call on all residents, fellows, interns and nutrition support practitioners to submit a poster for our next GASPEN annual meeting. Your poster will be showcased during our annual conference and on our GASPEN YouTube channel. For more information, email us at GASPENGA@gmail.com.
We’re so grateful for your support. Without you, our chapter wouldn’t be able to continue to thrive. Continue to support us through volunteering in a variety of GASPEN committees and sharing your suggestions and comments for CE programs, newsletter articles and any other ways that we can benefit our members. You can now connect with us through email, LinkedIn, Twitter, Facebook and our website. On behalf of our entire GASPEN board, thank you for being part of GASPEN. I look forward to another wonderful year!
Vivian Zhao, PharmD, BCNSP, FASPEN
GASPEN President
The Relationship Between Increased Phosphorus Utilization and Resolution of Refeeding Syndrome
Rachel Leong, PharmD | Nutrition Support Pharmacy Fellow, Emory University Hospital
Refeeding syndrome (RFS) is defined by the drastic and potentially fatal shifts in fluids and electrolytes that occur when malnourished patients receive enteral or parenteral nutrition. 1 These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark sign of refeeding syndrome is hypophosphatemia, however other characteristics include hypokalemia and hypomagnesemia. (2,3) These changes are a result of the sudden initiation of nutritional replenishment which lead to rising glucose levels in the bloodstream. With rising glucose levels, insulin secretion increases which drive phosphorus and potassium intracellularly. This leads to a decrease in the amount of available extracellular potassium due to the need for phosphorylation of glucose in glycolysis, but also through direct stimulation of the sodiumpotassium adenosine triphosphate pump. 4 The increase in insulin and shift of electrolytes lead to the various clinical features of RFS. Symptoms are a reflection of these changes and can lead to potentially damaging complications such as cardiac failure, dehydration or fluid overload, hypotension, renal failure, and sudden death. (3,5)
The lack of a universally accepted definition for RFS and the nonspecificity of the clinical manifestations of RFS, make this potentially serious condition frequently overlooked. 4 There are no current studies analyzing the recovery time for refeeding syndrome. The proposed study will aim to identify the amount of time required for refeeding to resolve after initiation of parenteral nutrition for hospitalized adults. Both the American Society for Parenteral and Enteral Nutrition (ASPEN) and the National Institute for Health and Clinical Excellence (NICE) refeeding syndrome risk criteria will be utilized to assess patients’ refeeding risk and potentially help to determine electrolyte needs to avoid worsening of RFS. This study will add to existing knowledge of RFS by further assessing its duration and average amount of electrolytes that should be provided when initiating parenteral nutrition in adult patients.
I have recently started the data collection process and look forward to sharing my findings in future GASPEN and ASPEN meetings.
References:
1. da Silva JSV, Seres DS, Sabino K, et al. ASPEN Consensus Recommendations for Refeeding Syndrome [published correction appears in Nutr Clin Pract. 2020 Jun;35(3):584-585]. Nutr Clin Pract. 2020;35(2):178-195.
2. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495-1498.
3. Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition. 2001;17(7-8):632-637.
4. Cioffi I, Ponzo V, Pellegrini M, et al. The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature. Clin Nutr. 2021;40(6):3688-3701.
5. Persaud-Sharma D, Saha S, Trippensee AW. Refeeding Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 12, 2021.
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