surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2019-9-2-118-124surgonco-383Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASESРефидинг-синдром у пациентов хирургического профиля. Анализ клинических случаевRefeeding Syndrome in Surgical Patients. A Clinical Case AnalysisНартайлаковМ. А.NartailakovM. A.

Нартайлаков Мажит Ахметович — д.м.н., член-корреспондент РАЕН, профессор, зав. кафедрой общей хирургии с курсом лучевой диагностики ИДПО, директор НИИ новых медицинских технологий

Nartailakov Majit Akhmetovich — Doctor of Medical Sciences, Corresponding Member of Russian Academy of Natural Sciences, Professor, Head of the Department of General Surgery with the course of Radiological diagnosis in the Institute of Additional Professional Education, Director of the Scientific Research Institute of New Medical Technologies

СалимгареевИ. З.SalimgareevI. Z.

Салимгареев Ильдар Зуфарович — к.м.н., зав. отделением гастрохирургии

Salimgareev Ildar Zufarovich — Candidate of Medical Sciences, Head of the Department of Surgical Gastroenterology

ПантелеевВ. С.PanteleevV. S.

Пантелеев Владимир Сергеевич — д.м.н., зав. отделением лазерной хирургии

Panteleev Vladimir Sergeevich — Doctor of Medical Sciences, Professor, Head of the Laser Surgery Department

НагаевФ. Р.NagaevF. R.

Нагаев Фарит Робертович — врач-хирург отделения гастрохирургии

Nagaev Farit Robertovich — Surgeon at the Department of Surgical Gastroenterology

ПогадаевВ. В.PogаdaevV. V.

Погадаев Вадим Валерьевич — врач-хирург отделения гастрохирургии

Pogadaev Vadim Valer’evich — Surgeon at the Department of Surgical Gastroenterology

РезяповВ. В.RezyapovV. V.

Резяпов Вадим Вакилевич — врач-хирург отделения гастрохирургии

Rezyapov Vadim Vakilevich — Surgeon at the Surgery Department №4

ИвановИ. И.IvanovI. I.

Иванов Иван Иванович — врач-хирург отделения гастрохирургии

8 937 316 17 18

Ivanov Ivan Ivanovich — Surgeon at the Department of Surgical Gastroenterology

van245@yandex.ruБашкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationРеспубликанская клиническая больница им. Г.Г. КуватоваРоссияG.G. Kuvatov Republican Clinical HospitalRussian FederationРеспубликанская клиническая больница им. Г.Г. Куватова; Башкирский государственный медицинский университетРоссияG.G. Kuvatov Republican Clinical Hospital; Bashkir State Medical UniversityRussian Federation20192907201992118124Copyright © Нартайлаков М.А., Салимгареев И.З., Пантелеев В.С., Нагаев Ф.Р., Погадаев В.В., Резяпов В.В., Иванов И.И., 20192019Нартайлаков М.А., Салимгареев И.З., Пантелеев В.С., Нагаев Ф.Р., Погадаев В.В., Резяпов В.В., Иванов И.И.Nartailakov M.A., Salimgareev I.Z., Panteleev V.S., Nagaev F.R., Pogаdaev V.V., Rezyapov V.V., Ivanov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/383Введение

Введение. Рефидинг-синдром — это состояние, в основе которого лежат метаболические нарушения, возникающие в результате возобновления питания у пациентов после длительного голодания. Истинная частота потенциально опасного для жизни синдрома повторного кормления неизвестна. В этой связи целью настоящей работы является демонстрация на примере клинического случая клинической картины и методов разрешения рефидинг-синдрома.

Материалы и методы

Материалы и методы. На примере пациентки с острым панкреатитом средней тяжести продемонстрирована клиническая картина рефидинг-синдрома с выраженной неврологической и кардиологической симптоматикой при возобновлении энтерального питания. Представлен обзор доступной литературы на данную тему.

Результаты и обсуждение

Результаты и обсуждение. Диагностический поиск проводился в широком диапазоне —исключались острая коронарная и неврологическая патологии. По данным дополнительных лабораторных методов исследования было сформировано предположение о развитии рефидинг-синдрома, проведена коррекция лечения. Применялось парентеральное введение фосфатсодержащих препаратов, а также энтеральное питание, в составе которого имеются фосфаты. Пациентка переведена на долечивание в неврологическое отделение. Выписана на 53-е сутки с полным регрессом неврологической симптоматики.

Introduction

Introduction. Refeeding syndrome is a condition underpinned by metabolic disorders emerging as a result of the resumption of feeding in patients after a protracted period of starvation. The real figures of the potentially life threatening refeeding syndrome incidence are unknown. This paper aims to demonstrate the clinical picture and methods of resolving of the refeeding syndrome by presenting a clinical case.

Materials and methods

Materials and methods. The clinical presentation of the refeeding syndrome with pronounced neurological and cardiological symptoms is demonstrated on the example of a female patient with acute pancreatitis of medium severity at the resumption of enteral feeding. A review of available literature on the subject is also presented.

Results and discussion

Results and discussion. The range of diagnostic considerations was rather broad as the authors had to eliminate acute coronary and neurological disorders. The auxiliary laboratory examination methods helped form the hypothesis of a developing refeeding syndrome and correct the treatment. Parenteral phosphate-containing preparations and enteral feeding with phosphates were administered. The patient was transferred to the neurology department for further treatment. The patient was discharged home on day 53 with total regression of neurological symptoms.

Conclusion

Conclusion. Hypophosphataemia — a very low level of phosphorus in blood — is a key clinical marker of the syndrome. However, low blood levels of potassium, calcium, magnesium and vitamin В1 may also play a role. Chronically undernourished patients and those not having any enteral feed for over 10 days are fall in the high risk group. The feeding should be resumed at a low level energy intake. Vitamins should be prescribed at the resumption and continued for at least 10 days. The electrolyte and fluid balance does not have to be corrected prior to the resumption of feeding; it can be done simultaneously with feeding.

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The authors declare that there are no conflicts of interest present.