Refeeding syndrome



Background

  • Occurs when malnourished person begins to eat.
  • Sudden carbohydrate → anabolic state → unmasks profound ↓↓ PO4.
  • New carbohydrate & insulin → K+, Mg2+ → into cells.

At risk

↓ intake (any reason)

  • "Alcoholics" in CDU, anorexia nervosa......

↓ absorption

↑ catabolic state

  • Any inflam. process, Infection, mitotic disease

Clinical

  • Heart failure (may be 20 to ↑Na+/ fluid overload)
  • GI upset
  • Myalgia ±rhabdomyolysis, ±resp. fatigue, ±tetany (↓Ca++).
  • Occult or overt Wernicke's encephalopathy
  • Acute liver failure
  • Marrow failure with thrombocytopenia/anaemia

Investigations

  • ↓↓PO4, ↓↓Mg2+
  • ↓K+
  • Hyperglycaemia

Management

  • Recognise!
  • A,B,C approach ±Airway Mx ±Arrhythmia Mx.
  • Pabrinex/multivitamins in all.
  • Monitor / correct electrolyie changes (esp. K+, PO4, Mg++).
  • Gradual restoration of carbohydrates and Na+.
  • Seek and treat underlying cause/pathology.
  • Involve dietetics (not available in CUH CDU).


Content By Dr Íomhar O' Sullivan, Dr Kanti Dasari 13 February 2019. Last review Dr ÍOS 14/02/19.