Refeeding Syndrome
Risk factors
- Eating disorders
- Oncology
- ICU
- <70% ideal wt, BMI <16, rapid wt loss, >5 days no intake,
- low PO4, Mg, K prefeeding
Fluid and electrolyte shift when refeeding malnourished patients (Enteral or TPN) with shift to anabolism
- Hypophosphatemia (nadir is in first week), Hypokalemia
- deminished in stavation, glucose > insulin release > PO4/K/Mg into cells
- not enough to make ATP?
- Vitamin (eg, thiamine) deficiencies
- low prior exacerbated by the new anabolic load
- Congestive heart failure
- heart atrophies in starvation
- Thiamine deficiency contributes
- Na and fluid retention
- Impaired contractility, increased stroke volume, failure and arythmias
- bradycardia expected so 'normal' ie >70 might be warning of cardiac compromise
- Respiratory failure
- from pulmonary oedema
- from impair diaphragm from hypophosphatemia
- Peripheral edema
- insulin increased Na resorption in kidneys and with in H2O
- Rhabdomyolysis
- myalgia, weakness, tetany
- from phypophosphatemia
- Seizures
- from electrolyte abnormalities
- other neuro from vitamin def exacerbation Rx with thiamine prior to and with refeeding
- Hemolysis
- GIT
- diarrhoea from atrophied villi/pancreas: Rx with elemental diet, resolved within a week
Rx correct PO4, Mg, K