Cameron McLean

Aims: This consensus statement document describes the recommendations of the Australasian Society of Parenteral and Enteral Nutrition regarding the identification and management of refeeding syndrome and refeeding syndrome risk.Methods: An expert working group completed a review of the literature to develop recommendations for the consensus statements. Review of the drafted consensus statements was undertaken by highly experienced clinicians.Results: The identification and management of refeeding syndrome requires a multidisciplinary approach. Actual refeeding syndrome is rare; however, all patients should be assessed for the risk of its development. Refeeding syndrome should only be diagnosed if the patient has had adequate nutrition intake (≥50% of estimated requirements), with electrolyte imbalances and clinical symptoms emerging after its commencement. Thiamin and multivitamin supplementation and regular electrolyte monitoring should be provided to all patients at risk of developing refeeding syndrome. There is no evidence that patients at risk of developing refeeding syndrome should be started at an initial lower enteral feeding rate than already recommended for checking tolerance to enteral feeds. Goal nutrition rates should be reached within 24–72 h for all routes of nutrition. Low electrolyte levels should be replaced as per local guidelines, with consideration given to the route of replacement.Conclusion: These consensus statements are expected to provide guidance at a national level to improve the identification and management of refeeding syndrome and refeeding syndrome risk.

Introduction: Patients discharged from hospital following alcohol withdrawal may require follow up of chronic nutrition concerns such as malnutrition and micronutrient deficiency. There is little known about the nutrition care provided in the primary healthcare setting supporting patients discharged from hospital. Aim: The aim of this study was to explore the nutrition care provided across New South Wales for patients discharged post alcohol withdrawal. Methods: A survey was distributed to all Primary Health Networks (PHNs) in New South Wales (NSW) and included participant demographics, information regarding participant confidence providing nutrition care and the types of care provided in this setting. Survey participants were also invited to undertake a semi-structured interview to explore hospital discharge processes using case studies. Survey responses were descriptively analysed and all data provided were utilised, even if incomplete. Qualitative data were thematically analysed and a description provided. Results: Of the 37 survey responses, 15 were fully completed with 41.1% of respondents rating themselves as confident to very confident to provide nutrition-related care. Four respondents participated in the follow-on interviews. Three themes emerged: the importance of person-centred and collaborative approaches; barriers to accessing nutrition services; and the impact of COVID-19 on discharge care. Conclusions: The level of reported confidence was variable among healthcare professionals providing nutrition care to patients discharged from hospital post alcohol withdrawal. This may represent a gap in service provision, implicating the need for advocacy on nutrition care following alcohol withdrawal.

This article reviews nutritional considerations in patients who drink at risky levels or have alcohol dependence. It aims to enhance GPs’ awareness of nutritional considerations in this patient group.

To explore the perspectives of dietitian assistants in a tertiary teaching hospital in Sydney, Australia, following the implementation of a formal competence and professional development program. All currently employed dietitian assistants at a tertiary teaching hospital in Sydney were eligible to participate. Semi-structured interviews were undertaken by two student dietitians. Transcripts were returned to participants for interviewee transcript review and further clarification of information. Transcripts were qualitatively described. A total of 9 dietitian assistants participated in interviews in October 2019. The average age of participants was 45.11 yrs (range 29-59) and 90% were female (n=8). The average length of employment was 197 months (range 3-516). Three themes emerged including: (a) new job satisfaction, (b) positive influence of the dietitian assistant educator, and (c) challenges of new processes and responsibilities. A supported structured competence and professional development program has provided dietitian assistants with new skills and renewed job satisfaction. Further research should consider the impact of the newly developed skills of dietitian assistants on patient care and outcome measures.

Aim: The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. Methods: A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013–2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. Results: A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22–70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70–27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0–6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300–6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. Conclusion: Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.

Aim: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved.Methods: The review protocol was registered with PROSPERO (CRD42017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics.Results: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions. Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions.Conclusions: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal.