- In the 1980s, the concept of parenteral hyperalimentation or hypercaloric feeding was dominant.
- this was stopped due to the sequelae, which limit attempts to rapidly correct malnutrition
- some early studies suggesting harm from early feeding were actually showing the effects of overfeeding
RISK FACTORS FOR OVERFEEDING
- extremes of size (e.g. very small, or very large) are susceptible
- non-protein calories are not included (e.g. glucose in IV fluids, lipid in propofol)
- errors in height or weight measurements /estimates or calculations
- failure to account for clinical state (e.g. decreased energy needs from sedation and mechanical ventilation)
- use of parenteral nutrition
- hyperglycemia: osmotic diuresis, infection, hypertonic dehydration
- hyperlipidemia: hyperviscosity, immunosuppression, infections, pancreatitis, steatohepatitis, fat overload syndrome
- hypercapnia: respiratory acidosis, tachycardia, tachypnea, prolonged weaning from ventilator
- liver dysfunction, abnormal LFTs (cholestasis, transaminitis), steatohepatitis
- refeeding syndrome
References and Links
- Griffiths RD. Too much of a good thing: the curse of overfeeding. Crit Care. 2007;11(6):176. PMC2246202.
- Klein CJ, Stanek GS, Wiles CE 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc. 1998 Jul;98(7):795-806. PMID: 9664922.
- Schulman RC, Mechanick JI. Can nutrition support interfere with recovery from acute critical illness? World Rev Nutr Diet. 2013;105:69-81. PMID: 23075588.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.