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The Reply

      The authors thank Dr Windpessl for the letter referring to our article.
      • Kirkland L.L.
      • Shaughnessy E.
      Recognition and prevention of nosocomial malnutrition: a review and a call to action!.
      We agree that recognizing and treating refeeding syndrome are important for any clinician treating at-risk patients. However, our article describes the epidemiology and lack of recognition of malnutrition as overarching concerns. We feel a specific syndrome is beyond the scope of our article.

      Reference

        • Kirkland L.L.
        • Shaughnessy E.
        Recognition and prevention of nosocomial malnutrition: a review and a call to action!.
        Am J Med. 2017; 130: 1345-1350

      Linked Article

      • Recognize Malnutrition but Avoid Refeeding Syndrome
        The American Journal of MedicineVol. 131Issue 6
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          In their otherwise comprehensive review article on nosocomial malnutrition, Kirkland et al1 do not mention an important aspect of inpatient nutritional support, namely the risk of refeeding syndrome. This term encompasses the metabolic disturbances and their associated adverse consequences during reinitiation of nutrition in malnourished individuals. Although the clinical manifestations are linked to various electrolyte and vitamin abnormalities, hypophosphatemia is regarded as both a hallmark and a sentinel sign.
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