Rates of adult acute inpatients documented as at risk of refeeding syndrome by dietitians.

BACKGROUND & AIMS: Identification of Refeeding Syndrome (RFS) is vital for prevention and treatment of metabolic disturbances, yet no information exists that describes identification rates by dietitians in acute care. We aimed to describe rates and demographics of inpatients identified by dietitians as at-risk of RFS and factors associated with electrolyte levels post-dietetic assessment. METHODS: Eligible participants were adult (≥ 18 yrs) acute care inpatients reviewed by dietitians between March 2012-February 2013 and not admitted to intensive care prior to first dietetic assessment. Patient information was sourced from medical charts. Chi-squared, t-tests and linear regression analyses were conducted. RESULTS: Of 1661 eligible inpatients (55%F, 65 ± 18 yrs), 9% (n = 151) were documented as at-risk of RFS in the first dietetic medical chart entry. On average, patients identified with RFS-risk had four days greater hospital stay, were 13 kg lighter, more likely classified SGA C (36% vs. 7%), and on a modified diet (52% vs. 35%) than non-RFS patients (p < 0.05). Very low and low electrolyte values occurred within seven days post-dietetic assessment in 7% and 52%, respectively, of inpatients with RFS-risk. Regression analysis showed that electrolyte supplementation was positively associated (ß = 0.145-0.594), and number of RFS-related risk factors negatively associated (ß = -0.044-0.122), with potassium, magnesium and phosphate levels within seven days post-dietetic assessment (p < 0.05). CONCLUSION: Nine percent of adult inpatients were documented as at-risk of RFS by dietitians. Identification of at-risk patients was in accordance with RFS guidelines. Electrolyte supplementation was positively associated with electrolyte levels post-assessment. Consistency of RFS-risk identification between dietitians requires determination.

Energy and protein intakes of hospitalised patients with acute respiratory failure receiving non-invasive ventilation.

BACKGROUND & AIM: Nutritional intake of patients in acute respiratory failure receiving non-invasive ventilation has not previously been described, and no protocols have been developed to guide practice to optimise nutritional status. We aimed to measure energy and protein intakes of patients in acute respiratory failure requiring non-invasive ventilation receiving standard hospital nutritional care. METHODS: Food and fluid intake forms were completed by nursing staff for all meals and mid meals for patients admitted with respiratory failure commencing on non-invasive ventilation. Intake was converted from quartiles of food consumed into energy and protein to enable comparison with estimated daily requirements using descriptive statistics. Multinomial stepwise regression analysis was used to determine factors associated with inadequate protein and energy intake. RESULTS: Over 283 total days of intake, 36 participants (67% female, aged 65 ± 9 years) achieved on average 1434 ± 627 kcal and 63 ± 29 g protein daily. Overall, 28 patients (78%, 95% CI: 61-90%) met less than 80% of estimated energy requirements and 27 patients (75%, 95% CI: 58-88%) met less than 80% of estimated protein requirements. Being fed orally, longer time on non-invasive ventilation and higher BMI were associated with poorer intakes. Better nutritional status on admission and measuring intake closer to hospital discharge was associated with improved intakes. CONCLUSION: Patients with acute respiratory failure requiring non-invasive ventilation often had inadequate oral intake, particularly with increasing time on non-invasive ventilation, and earlier during their hospital admission. Development of protocols to optimise nutritional intake for these patients may improve outcomes and reduce regular readmission rates.