High protein enteral tubefeeding solution. NICE guidelines regarding refeeding syndrome, based on a very cautious refeeding regime reaching estimated calorie and protein needs within 7 days, compared to a protocol at Diakonhjemmet Hospital using a higher starting rate, reaching estimated needs within 3 days.

High protein enteral tubefeeding solution. The intervention group, Diakonhjemmets feeding protocol, will start at 20 calories a kg a day, and increasing until estimated needs are met within 3days

Refeeding Syndrome

NICE guidelines regarding refeeding syndrome, based on a very cautious refeeding regime reaching estimated calorie and protein needs within 7 days, compared to a protocol at Diakonhjemmet Hospital using a higher starting rate, reaching estimated needs within 3 days.

Tubefeeding

Diakonhjemmet Hospital

Refeeding Syndrome Among Older Adults

Safe Refeeding of Severely Malnourished Patients 65 Years or Older

Using Jamar Pluss Digital +, Measuring change in kg from baseline, day 4, 7 and at 3months.

Health related quality of life. Questionnaires

Screening instrument for cognitive impairment and delerium.

Measuring bodyweight during patients hospital stay, starting at day one of tubefeeding, and then day 4 and on day 7, and at 3 months after last tubefeeding day (with approximatly one week discrepancy)

Diagnosis set by a medical doctor. C-reactive protein (CRP), erythrocytes, sedimentation rate (ESR), white blood cells (WBC), and differential leukocyte count.

Defined as the total number of hospital days before discharge, either to a nursing home, home with homecare or home without further assistance.

Complications might be: constipation, edema, nausea and vomiting, hypoglycemia and cardiac abnormalities, and tubedislocation

Sissel Urke Olsen

Clinical Dietitian

Norwegian Health Association

Refeeding protocol: Standardised refeeding protocols will be used for each of the patient groups; the control group will start tube feeding at 5 or 10 kcal/kg/day depending on their BMI and increase until needs are met within 7 days. The intervention group will start tube feeding at 20 kcal/kg/day and increase until needs are met within 3 days, but continue feeding minimum of 7days. Electrolytes will be monitored daily The patients will receive100 mg thiamine, and 1 multivitamin/mineral daily, all recorded in the medical journal. The intervention group will receive approximately 40% higher amount of protein and calories compared to the control group in the end of day 7.

Patients and care provider(nurse) will be masked(not informed), Patients will be screened (height and weight) and handgrip strength will be performed by the investigator. Patients will sign a written consent, and then randomized to either the control or an intervention group. Patients will be tested on day 4, 7 and at 3 months by a research assistant/outcome assessor and is blinded treatment allocations. Blood tests are drawn daily. A nurse will administered the tubefeeding according to written orders in the medical journal; nurses are not informed about treatment allocation or the outcome measures. Physicians are informed about the study, but will not know what treatment patients will receive.

hypophosphatemia/turse

Refeeding Syndrome Among Older Adults

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