Afet ve Acil Durumlarda Uzun Süreli Açlık Sonrası Beslenme Yönetimi: Metabolik Stabilite Tabanlı Klinik Yaklaşım
Synopsis
In disaster and emergency settings, nutritional rehabilitation after prolonged starvation should be regarded not merely as caloric replacement but as a controlled metabolic reactivation process with substantial physiological risk. Starvation induces complex hormonal and metabolic adaptations characterized by insulin suppression, ketosis, and intracellular electrolyte depletion. Uncontrolled refeeding may precipitate refeeding syndrome through rapid intracellular shifts of phosphate, potassium, and magnesium, resulting in life-threatening metabolic collapse manifested by cardiac arrhythmias, respiratory failure, neurological deterioration, and multiorgan dysfunction. This chapter reviews the metabolic adaptations to prolonged starvation, the pathophysiology and clinical consequences of refeeding syndrome, and evidence-based principles for gradual nutritional rehabilitation. Risk stratification, metabolic monitoring strategies, and stepwise feeding protocols applicable to disaster settings are discussed in light of current literature. Additionally, a field-adapted clinical framework, the Metabolic Stability-Based Gradual Refeeding Algorithm (MSGRA), is proposed to support structured decision-making in resource-limited environments. Ultimately, the primary objective of refeeding management is not rapid nutritional replenishment but the safe restoration of metabolic stability while minimizing preventable complications.
References
Birmingham, C., Puddicombe, D., & Hlynsky, J. (2004). Hypomagnesemia during refeeding in anorexia nervosa. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9(3), 236-237.
Boateng, A. A., Sriram, K., Meguid, M. M., & Crook, M. (2010). Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition, 26(2), 156-167.
Cahill Jr, G. F. (2006). Fuel metabolism in starvation. Annu. Rev. Nutr., 26(1), 1-22.
Crook, M. A. (2014). Refeeding syndrome: problems with definition and management. Nutrition, 30(11-12), 1448-1455.
Culyer, A., McCabe, C., Briggs, A., Claxton, K., Buxton, M., Akehurst, R., . . . Brazier, J. (2007). Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence. Journal of health services research & policy, 12(1), 56-58.
da Silva, J. S., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., . . . Gura, K. M. (2020). ASPEN consensus recommendations for refeeding syndrome. Nutrition in Clinical Practice, 35(2), 178-195.
Fuentebella, J., & Kerner, J. A. (2009). Refeeding syndrome. Pediatric Clinics, 56(5), 1201-1210.
Hall, J. E. (2021). Guyton y Hall. Compendio de fisiología médica: Elsevier Health Sciences.
Handbook, S. (2011). Humanitarian charter and minimum standards in humanitarian response: International Federation of Red Cross and Red Crescent Societies.
Holdoway, A., & Franklin, H. (2021). Optimising nutritional care and combatting malnutrition. Journal of Community Nursing, 35(6).
Holdoway, A., & Franklin, H. (2022). Optimising nutritional care and combatting malnutrition. Journal of General Practice Nursing, 8(1), 61-68.
Kraft, M. D., Btaiche, I. F., & Sacks, G. S. (2005). Review of the refeeding syndrome. Nutrition in Clinical Practice, 20(6), 625-633.
Mason, J. B. (2002). Lessons on nutrition of displaced people. The Journal of nutrition, 132(7), 2096S-2103S.
Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: what it is, and how to prevent and treat it. Bmj, 336(7659), 1495-1498.
Parli, S. E., Ruf, K. M., & Magnuson, B. (2014). Pathophysiology, treatment, and prevention of fluid and electrolyte abnormalities during refeeding syndrome. Journal of Infusion Nursing, 37(3), 197-202.
Sechi, G., & Serra, A. (2007). Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. The Lancet Neurology, 6(5), 442-455.
Silva, J. E. (2006). Thermogenic mechanisms and their hormonal regulation. Physiological reviews.
Skipper, A. (2012). Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. Nutrition in Clinical Practice, 27(1), 34-40.
Solomon, S., & Kirby, D. (1990). The refeeding syndrome: a review. Journal of Parenteral and Enteral Nutrition, 14(1), 90-97.
Steiner, L., & Hewlings, S. (2021). A systematic review of the role of thiamine supplementation in treatment of refeeding syndrome. Topics in Clinical Nutrition, 36(1), 36-51.
World Health Organization. (2013). Guideline: updates on the management of severe acute malnutrition in infants and children: World Health Organization.
