PP351 - REFEEDING SYNDROME IN PARENTERAL NUTRITION: WIDE VARIATION IN PREVALENCE AND POOR AGREEMENT ACROSS DEFINITION

PP351

REFEEDING SYNDROME IN PARENTERAL NUTRITION: WIDE VARIATION IN PREVALENCE AND POOR AGREEMENT ACROSS DEFINITION

L. W. Hathurusinghe^1,2, E. Salazar^1,3,*, R. J. H. Ng¹, M. C. C. Cheah^1,3, P. B. Yen⁴, L. Y. Cheang⁴, R. J. L. Goh⁴, M. S. Lee⁵, L. B. Tan⁵

¹Gastroenterology and Hepatology , Singapore General Hospital, Singapore, Singapore, ²Post Graduate Institute of Medicine,Colombo, Colombo, Sri Lanka, ³Duke-National University of Singapore, ⁴Divion of Pharmacy, ⁵Dietetics Department, Singapore General Hospital, Singapore, Singapore

Rationale: Refeeding syndrome (RFS) is potentially lethal, but prevalence varies wide due to inconsistent definitions, limiting recognition and prevention. This study compared prevalence and agreement across commonly used definition in adult inpatients receiving parenteral nutrition (PN) 

Methods: We conducted a retrospective analysis of an inpatient PN registry at a tertiary hospital from January 2021 to December 2022. Adult inpatients receiving PN with baseline and follow-up (post PN up to 72 hours) electrolytes (phosphate, potassium, magnesium) were included. RFS was defined using ASPEN 2020 criteria (≥10% decrease to the lowest electrolyte within 72 hours; mild 10–20%, moderate 20–30%, severe >30%), a NICE-consistent definition (≥30% phosphate reduction), and clinician-assessed risk. Agreement was evaluated with Cohen’s kappa.

Results: Among 702 patients (median age 67 years, 58.1% male, 87.5% surgical), median PN duration was 9 days, most were SGA B (60.4%). Clinicians classified 74.4% at risk and 78.4% received thiamine. RFS prevalence differed widely; ASPEN 69.3% (moderate–severe 49.3%) vs NICE 25.9%.  Higher day 1 energy intake was associated with increased moderate–severe ASPEN RFS (<10 vs >20 kcal/kg: 36.7% vs 58.4%, p=0.04). Electrolyte nadirs occurred early, particularly phosphate (58.1% by day 2). Agreement between clinician assessment and definitions was poor (κ≈0). ASPEN vs NICE agreement was modest (κ=0.25, p<0.001).

Conclusion: RFS is common in PN patients and highly definition-dependent. Higher initial caloric delivery increases risk, supporting cautious feeding and early monitoring. Poor agreement between definitions and clinician assessment highlights the need for standardized criteria to improve recognition and management

Disclosure of Interest: None declared