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Transcript of Refeeding Syndrome
"Refeeding Syndrome: A Literature Review"
By L.U.R. Kan, J. Ahmed, S. Khan, and J. MacFie
Gastroenterology Research and Practice
Vol 2011 p1-6.
No randomised controlled trails
Aggressive oral, enteral or parenteral CHO feeding following a period of nutritional deprivation (i.e. starvation, anorexia, malnutrition)
Sudden influx of glucose into cells
Shift of extracellular to the intracellular of glucose leads to phosphate, magnesium and potassium not able to keep up with the abrupt shift
Severe mineral and fluid imbalance can lead to cardiac arrest, neurological complications, hepatic and respiratory dysfunction
Identification of patients at risk of RFS
Effective communication with Drs
Daily monitoring of electrolytes
Slowly upgrading feeds/orally for patients
? Development of protocol/algorithm for dietitians and Dr's use
What is Refeeding Syndrome (RFS)?
Metabolic and biochemical change
Fatal shifts in fluids and electrolytes that may occur in malnourished patients (oral, enteral or parenteral)
Consequence of reintroduction of feeding after a period of starvation or fasting
Leads to non immune-mediated harm to body (mild, moderate or severe)
No clear definition or diagnostic criteria
What is Refeeding Sydrome?
Recommendations and other guidelines
Physiology - Refeeding Syndrome
At risk of RFS
Management of RFS
Correct biochemical abnormalities and fluid imbalances
Prevention is essential
Identifying at risk individuals
Monitoring during refeeding and appropriate feeding regimen prescribed
Anticipate risk of developing
Thorough nutrition assessment conducted via dietitians
Effective communication within and between teams (multidisciplinary approach)
Feeding regimen in RFS
No protocol or guideline for dietitians to follow
Based on recommendations in table
Guidance from senior dietitians
? Dr's awareness and knowledge of management of RFS
Development of protocol for dietitians and Dr's use
To include topic on RFS during inservice for Dr's
Inclusion into orientation pack for dietitians
Monitoring pts at risk of developing RFS
BDA RFS Algorithm
Normal range 0.8-1.45 mmol/L
Essential for cell function
Neurological, cardiac, respiratory, and hematological levels, and can lead to death
The mortality rate in patients with severe hypophosphataemia is 30%.
Normal range (3.5-5.1 mmol/L)
Maintenance of membrane potential and regulation of glycogen and protein synthesis
Gastrointestinal systems such as nausea, vomiting and constipation and weakness
If untreated, can progress to severe condition with intramuscular dysfunction and disorders affecting myocardial contractility and signal conduction (can lead to sudden death)
Normal range (0.77-1.33 mmol/L)
Cofactor of numerous enzymes and regulation of different biochemical reactions
Usually asymptomatic (mild-moderate)
Symptomatic (severe <1mg/dL): neuromuscular dysfunction, electrocardiograph changes, cardiac arrhythmia and even death
Hydrosoluble vitamin necessary for CHO metabolism (acts as cofactor for pyruvate dehydrogenase and transketolases)
Advanced deficiencies leads to brain disorders such as Wernicke-Korsakoff syndrome
Increased in blood levels of pyruvate lactate
Excessive lactate rises lactic acidosis
Can lead to appearance of heart failure
RFS guidelines in Northern Health Hospital
Team Learning: 8th March 2013
By Cindy Shea