refeeding syndrome
The patient whose potassium and phosphate levels drop with the reintroduction of nutrition has refeeding syndrome. They need electrolyte replacement. It is not rocket science.
| Headline | |
|---|---|
| Etiology | first week of refeeding - electrolyte shifts. |
| Epidemiology | |
| Clinical presentation | pulmonary oedema, heart failure, arrhythmia, encephalopathy ↓ phosphate, ↓ K, ↓ Mg HAEM: poor platelet function MSK: rhabdo??? tetany, muscle weakness (leading to prolonged vent weans etc.) |
| Pathogenesis | Insulin release, thiamine depletion. Total body phosphate stores depleted - lost when muscle broken down, then in urine → depleted further with glycolysis when carbohydrates are introduced Insulin release = ↓ K Thiamine is a cofactor for carbohydrate metabolism |
| Diagnostic investigations | |
| Management | Replace what's lost Careful slow refeeding - dieticians will guide ...it really isn't rocket science |
risk assessment
HIGH RISK: Patients classified as high risk have two or more of the following:
- BMI less than 18.5 kg/m2
- Frail elderly patients assessed by the dietitian as being at nutritional risk
- Unintentional weight loss greater than 10% within the last 3 – 6 months
- Little or no nutritional intake for more than 5 days
- Morbidly obese patients with rapid weight loss (e.g. after gastric ballooning or banding)
- Oncology therapy (i.e chemo or radiation treatments) especially head/neck/gastrointestinal patients
- Major stressors without food for > 3 days
- Post-operative or fasted for long periods of time
Extremely high risk:
- BMI less than 16 kg/m2
- Anorexia nervosa
- Unintentional weight loss greater than 15% within the last 3 – 6 months (includes obese patients)
- Little or no nutritional intake for more than 10 days
- Low levels of potassium, phosphate or magnesium prior to feeding
- However normal serum levels do not mean that the patient is not at risk. Their total body stores may be significantly depleted
- Chronic malnutrition:
- Alcoholism
- Marasmus
- Kwashiorkor
- Hunger strikers
- Malabsorption states