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Purpose of Review <p>To give a concise update on three life-threatening yet reversible nutritional emergencies—refeeding syndrome (RFS), key micronutrient deficiencies, and malnutrition-related hyperammonemia—relevant to today’s surgical and critical-care practice.</p> Recent Findings <p>Current guidelines emphasize two themes: (1) screen early and load thiamine, phosphate, magnesium and potassium before calories; (2) escalate feeding only while electrolytes remain stable. New definitions (e.g. AuSPEN’s “manifest RFS”) formalize when to pause or slow calories, while data show that proactive electrolyte prophylaxis allows faster progress to full nutrition. Thiamine, B-12 and copper deficits still present as neurologic or hematologic “mimics,” and catabolic hyperammonemia, especially after bariatric surgery, may resolve with rescue nutrition plus ammonia-lowering therapy. Endoscopic gastrogastrostomy now provides a minimally invasive route to restore feeding access when conventional enteral options fail.</p> Summary <p>Timely risk screening, vitamin/electrolyte pre-loading and guideline-paced calorie advancement can convert these emergencies into manageable conditions; success depends on coordinated multidisciplinary care.</p>

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Nutritional Emergencies

  • 期刊论文

  • 发表日期：

    2025年8月7日

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  • Amir Y. Kamel,
  • Priyanka Shah,
  • Leonardo Zumerkorn Pipek,
  • Apeksha Shah,
  • Prem A. Kandiah

摘要

Purpose of Review

To give a concise update on three life-threatening yet reversible nutritional emergencies—refeeding syndrome (RFS), key micronutrient deficiencies, and malnutrition-related hyperammonemia—relevant to today’s surgical and critical-care practice.

Recent Findings

Current guidelines emphasize two themes: (1) screen early and load thiamine, phosphate, magnesium and potassium before calories; (2) escalate feeding only while electrolytes remain stable. New definitions (e.g. AuSPEN’s “manifest RFS”) formalize when to pause or slow calories, while data show that proactive electrolyte prophylaxis allows faster progress to full nutrition. Thiamine, B-12 and copper deficits still present as neurologic or hematologic “mimics,” and catabolic hyperammonemia, especially after bariatric surgery, may resolve with rescue nutrition plus ammonia-lowering therapy. Endoscopic gastrogastrostomy now provides a minimally invasive route to restore feeding access when conventional enteral options fail.

Summary

Timely risk screening, vitamin/electrolyte pre-loading and guideline-paced calorie advancement can convert these emergencies into manageable conditions; success depends on coordinated multidisciplinary care.