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Refeeding syndrome
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Refeeding syndrome
Dr Gemma Summons FY2
Pathogenesis
Risk factors
Definition
Incidence
Risk factors:
- anorexia nervosa or alcoholism
- cancer, post-op, elderly
- diabetes mellitus
- chronic malnutrition
- weight loss + rapidity of restoration
- electrolyte derangement
- no nutritional intake 5-10 days
- first 2 weeks of refeeding
- Unknown
- 0.43% (hypophosphataemia) hospitalised patients (Camp et al 1990)
- 18% of patients on TPN (with phosphate)
(Martinez et al 2006)
- 34% of ITU patients shortly after re-feeding
(Marik et al 1996)
Refeeding syndrome:
- Clinical complications of potentially fatal shifts in fluids and electrolytes
- Occurs during nutritional rehabilitation
- Malnourished patients receiving artificial feeding (oral, parenteral, enteral)
- Hypophosphataemia
- Also:
- thiamine deficiency
- hypokalaemia
- hypomagnesaemia
- altered glucose, protein and fat metabolism.
Clinical features develop due to electrolyte depletion and reduced BMR.
Image: http://flipper.diff.org/app/items/info/4867
NICE guidelines
Prevention
Clinical features
Treatment
NICE Guidelines
- Identify high-risk patients
- Thorough nutritional assessment prior to refeeding
- Weight change
- Nutrition and alcohol
- Social/psychological
- Measure electrolytes at baseline
- Correct deficiencies with close monitoring
- Start refeeding at no more than 50% energy requirements; increase over 4-7 days
- If BMI <14 start at 0.021 MJ/kg/24 hours, cardiac monitoring
- Vitamin supplementation for first 10 days
- Reduce nutritional support
- Correct hypophosphatemia, hypokalemia, and hypomagnesemia
- Dietician involvement
- Continuous cardiac monitoring (CVC, ART)
- Symptomatic management e.g. osmotic laxative
- Caution: renal impairment, hypo/hypercalcaemia
- Controlled fluid repletion
Mehanna et al. Refeeding syndrome: what it is, and how to prevent it and treat it. BMJ 2008;336:1495-8
Image: http://pb.rcpsych.org/content/pbrcpsych/31/6/209/F3.medium.gif