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Refeeding Syndrome
17
Transcript
Symptoms of refeeding syndrome
Background
Comparison of clinical guidelines
Thiamine deficiency
- Necessary for CHO metabolism
- Advanced deficiencies leads to brain disorders such as Wernicke-Korsakoff syndrome
- Can lead to appearance of heart failure
Hypophosphatemia
- Normal range: 0.8-1.6 mmol/L
- Essential for cell function
- Neurological, cardiac, respiratory and hematological levels and can lead to death
- Mortality rate in patients with severe hypophosphatemia is 30%
Hypomagnesaemia
Current Clinical Practice
Hypokalemia
Future Directions
- Normal range: 0.7-1.0mmol/L
- Co-factor of numerous enzymes and regulation of different biochemical reactions
- Usually asymptomatic (mild-moderate)
- Symptomatic (severe <1mg/dL) can lead to neuromuscular dysfunction, electrocardiograph changes, cardiac arrhythmia and even death
Pathphysiology
- Normal range: 3.5-5.0mmol/L
- Maintenance of membrane potential and regulation of glycogen and protein synthesis
- Gastrointestinal systems such as nausea, vomiting, constipation and weakness
- If untreated, can progress to severe conditions with intramuscular dysfunction and disorders affecting myocardial contractility and signal conduction (can lead to sudden death)
What is refeeding syndrome
- Development of refeeding syndrome guidelines – for dietitians and doctors reference
- Increase awareness within multidisciplinary team in particular Dr’s to treat early (replace electrolytes) & ? Hospital policy
- Considering thiamine, vitamin B and multivitamin supplementation prior feeding?
- Conducting comprehensive dietary assessment
- Identification of those at risk
- Highlighting to the Team
- Slow upgrade of feeds/oral intake
- Start at 10kcal/kg/day
- Approximately 50% of pt’s basal energy requirements
- Close monitoring and Drs to replace electrolytes as necessary
- Potentially life-threatening condition
- Characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure
- Consequence of re-introduction of feeding after a period of starvation
- No clear definition of diagnostic criteria
Incidence
- True incidence unknown
- No universally accepted definition
- Mainly based on case studies and prospective cohort studies
Refeeding Syndrome
Cindy Shea
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