With the release of thousands of detainees from the prisons of the ousted President Bashar al-Assad’s regime, as videos show the state of hunger and deprivation they were living in, fears arise that these freed people are suffering from refeeding syndrome. What is it?
In Saydnaya Prison – for example – the detainees were living in tragic conditions, as they were placed in small cells containing between 50 and 70 people, deprived of air and light for years, and receiving only a loaf of bread daily paid to them through a small hole under the door.
What is refeeding syndrome?
Refeeding Syndrome is a condition that occurs when a person suffering from malnutrition – such as detainees of the Bashar al-Assad regime – begins to eat and drink normally.
When food is served too quickly, it may cause serious complications. This happens because of the ways the body changes when it is deprived of nutrients. When a food-deprived person begins to refeed, their body has to change again, but the body may not have the ability to do so quickly.
Malnutrition means that the body is deprived of nutrients. When the body tries to metabolize nutrients again while returning to normal nutrition, severe shifts – linked to electrolyte deficiency – can occur in the body’s chemistry. It can cause serious complications affecting the muscles, lungs, heart and brain.
Who does refeeding syndrome affect?
Refeeding syndrome can affect anyone who has begun refeeding after experiencing malnutrition. If he doesn’t eat enough, he may suffer from malnutrition. Some medical conditions can also cause malnutrition. It can affect appetite, or the body’s ability to absorb nutrients from food, according to the Cleveland Clinic.
Some risk factors for malnutrition and refeeding syndrome include:
- Recently lost more than 10% of body weight.
- Food deprivation for more than 7 days with evidence of stress and exhaustion.
- Eating disorders such as anorexia nervosa and bulimia nervosa.
- Malabsorption disorders such as chronic pancreatitis and inflammatory bowel disease.
- Long-term parenteral nutrition (intravenous nutrition).
- Cancer and chemotherapy.
- Uncontrolled diabetes.
- Chronic alcohol abuse.
- Chronic overuse of antacids or diuretics.
How does refeeding syndrome occur?
When the body lacks nutrients, it makes some changes to adapt. It changes the metabolism (the way food is converted into energy. Instead of carbohydrates from food, the body metabolizes its own fat and muscle. Metabolism also slows down. The resting metabolic rate decreases) The amount of energy the body burns while at rest by up to To 20%.
This type of metabolism consumes fewer resources. It does not use micronutrients (vitamins, minerals, and electrolytes) the way normal metabolism does. But when a person begins refeeding, normal carbohydrate metabolism also begins. The body searches deep in its pockets for the micronutrients it needs to get the job done.
What causes refeeding syndrome?
This occurs due to low stores of certain micronutrients in the body. Stores are low when he is malnourished. The most common nutrients are phosphorus, potassium, and magnesium. When a person begins to refeed, your cells require these electrolytes to metabolize food, and this causes a sharp shift in body chemistry.
A person’s electrolytes move quickly from the blood into the cells, but because he doesn’t have enough of them, this transfer leaves low levels of them in the blood. Low electrolyte levels in the blood are called “deficiency.” It messes with your body chemistry. Electrolyte deficiency causes many different complications that can manifest as refeeding syndrome.
Symptoms of refeeding syndrome
Refeeding syndrome can manifest itself in several ways. The most common form is severe hypophosphatemia. But other deficiencies and imbalances may also contribute.
Phosphate deficiency
Hypophosphatemia (hypophosphatemia) is the most common feature of refeeding syndrome. Phosphate deficiency affects cellular processes throughout your body. May cause:
Muscle weakness.
- Difficulty breathing.
- Double vision.
- Swallowing problems.
- Seizures.
- Coma.
- Cardiomyopathy (weak heart).
- If you have severe symptoms, phosphate deficiency can cause organ failure, which can be fatal.
Magnesium deficiency
Magnesium is an important factor in metabolism. Magnesium deficiency (hypomagnesemia) affects every organ in your body. It may look like:
- Nausea and vomiting.
- Anorexia.
- Trembling.
- Muscle cramps.
- Seizures.
- Coma.
- Heart ischemia.
- Irregular heartbeat
Potassium deficiency
Mild potassium deficiency (hypokalemia) may not cause symptoms. But more severe deficiency may lead to:
- Muscle weakness.
- Muscle cramps.
- Fatigue.
- Severe constipation due to paralyzed bowel movements.
- Irregular heartbeat.
- Respiratory failure.
Thiamine (vitamin B1) deficiency
Thiamine deficiency is particularly caused by refeeding
Eat carbohydrates
Eating carbohydrates can lead to severe neurological symptoms, including:
- Delirium.
- Vision problems.
- Hypothermia.
- Ataxia (balance and coordination problems).
- amnesia.
- Visualization (creating false memories).
Body fluid disorders
Metabolic changes can affect the balance of sodium and water in the body. In refeeding, this can lead to either fluid overload or dehydration. This can cause:
- Low blood pressure.
- Muscle cramps.
- Pulmonary edema (fluid in the lungs).
- Kidney dysfunction.
- Congestive heart failure.
- spells.
Blood sugar problems
Reintroduction of glucose during refeeding can lead to hyperglycemia. This can lead to:
- headache.
- Blurred vision.
- Frequent urination.
- Fatigue.
How is refeeding syndrome treated?
Before starting refeeding, blood tests should be done to measure the person’s electrolyte levels to determine any deficiency. The doctor will then add the missing micronutrients to the person’s nutritional formula. The idea is to replace lost micronutrients first. After that, the body will be better prepared to metabolize carbohydrates.
Complications of refeeding syndrome
Complications from refeeding syndrome can lead to death, but are usually less severe. Once a doctor corrects the imbalances in question, most symptoms are reversible.
With the release of thousands of detainees from the hell of Assad’s prisons, it may not be possible to provide thousands of doctors to follow them, and here the families of the detainees are advised to provide food to them gradually, pay attention to the symptoms we mentioned earlier, and see and consult a doctor whenever possible.