{
  "abstract": "Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract which can be associated with weight loss or faltering growth. 1 When nutrition has been restricted the patient is at risk of developing refeeding syndrome (RFS).2 The presence of hypophosphataemia is a key indicator of RFS. Other biochemical abnormalities can occur during the early stages of RFS, including low levels of potassium and magnesium. RFS can have life-threatening consequences2 Exclusive enteral nutrition (EEN) is advised by ECCO-ESPGHAN ‘in children with active luminal CD, dietary therapy with exclusive enteral nutrition [EEN] is recommended as first line for induction of remission’.1 With this increase in nutritional intake, patients may be at increased risk of RFS.We aimed to evaluate whether children with newly diagnosed CD who underwent EEN as initial induction method were at risk of developing RFS, and if so if they would need treatment for electrolyte disturbance. We hypothesised that the risk of needing IV electrolyte replacement would be low.60 patients were identified from the departmental IBD database who had been diagnosed with Crohn’s disease over a 14 month period. Data was collected regarding demographics, anthropometry, EEN treatment, cardiovascular observations, potassium, phosphate and magnesium levels, and electrolyte replacement therapy. 7 patients were excluded as nutritional supplements had been initiated prior to EEN, 5 patients were excluded for insufficient biochemistry data. The remaining 48 patients were further divided into two risk groups based on percentage median Body Mass Index, weight loss and dietary intake.In total, 19 patients (39.6%) were observed to have an electrolyte disturbance following initiation of EEN. Of these, 13 needed electrolyte replacement (27.1%) and no patients needed IV replacement.There were 22 patients in the low risk group. Of these, 5 (22.7%) had electrolyte disturbances and only 1 (4.5%) required replacement which was oral.Of the 26 patients in the high risk group, 14 (53.8%) had electrolyte disturbances, and 12 patients (46.2%) needed electrolyte replacement.In 13 patients where electrolyte replacement was prescribed, all the patients needed oral phosphate replacement (100%) and 1 of these also needed oral magnesium replacement.No patients were admitted to critical care for management.This data suggests that the whilst the incidence of refeeding syndrome in this population is 39%, no patients required IV replacement despite their initial refeeding risk group. All patients were managed with oral supplements. Fewer patients identified as low risk required replacement. Patients are often admitted to start EEN due to concerns over refeeding syndrome but this study suggests community based EEN with blood monitoring, dietetic input and clinician overnight may be safe from a refeeding perspective.References Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, Amil Dias J, Barabino A, Braegger CP, Bronsky J, Buderus S, Martín-de-Carpi J, De Ridder L, Fagerberg UL, Hugot JP, Kierkus J, Kolacek S, Koletzko S, Lionetti P, Miele E, Navas López VM, Paerregaard A, Russell RK, Serban DE, Shaoul R, Van Rheenen P, Veereman G, Weiss B, Wilson D, Dignass A, Eliakim A, Winter H, Turner D. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. Journal of Crohn’s and Colitis Oct 2014;8(10):1179–1207. https://doi.org/10.1016/j.crohns.2014.04.005 Van Rheenen PF, et al. ‘The medical management of paediatric crohn’s disease: an ecco-espghan guideline update’. Journal of Crohn’s and Colitis 2020;15(2):171–194. doi:10.1093/ecco-jcc/jjaa161.",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Nathan Boydell"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Rebeccca Foulkes"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Lisa Charlton"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Rachel Wood"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Adnaan Kala"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital"
      ],
      "name": "Sian Copley"
    }
  ],
  "title": "OC5 Refeeding syndrome in patients commencing exclusive enteral nutrition for paediatric Crohn’s disease: a single centre experience",
  "uid": "f98542a3-9b48-5682-9904-94f3e46443bb"
}