06a: Refeeding Syndrome

Question 1

Re-feeding syndrome is a result of (X) support in a(n) (Y) host.

Answer 1

X = aggressive nutritional 
Y = malnourished

Question 2

Most common electrolyte anomaly in re-reeding syndrome.

Answer 2

Hypophosphatemia

Question 3

(X) is the primary drive of transcellular shifts of phosphate in re-feeding syndrome. List some other mechanisms that can contribute.

Answer 3

X = hyperinsulinemia

1. Hyperglycemia
2. Systemic alkalosis
3. Drugs

Question 4

T/F: In advanced stages of malnutrition, laboratory tests may be within normal ranges.

Answer 4

True - bone/tissue breakdown and dehydration

Question 5

When re-feeding is initiated, there’s a shift from (X) fuel metabolism to (Y) fuel metabolism. What triggers this shift?

Answer 5

X = fat
Y = CHO

Rise in insulin

Question 6

Re-feeding syndrome: Accompanying the (increased/decreased) glucose uptake by cells, which ions copy-cat glucose movement?

Answer 6

Increased;

K, Ca, PO4, Mg

Question 7

T/F: In re-feeding syndrome, the high glucose/ion movement and increased metabolism leads to protein breakdown.

Answer 7

False - protein synthesis activated with glucose/ion shifts into cell

Question 8

Re-feeding syndrome: What’s (synthesizing/utilizing) all the PO4, leading to (hyper/hypo)-phosphatemia?

Answer 8

Utilizing;
Hypophosphatemia;

Cell metabolism (high demand of phosphorylated intermediates)

Question 9

Re-feeding syndrome: What’s (synthesizing/utilizing) all the thiamine, (excess/deficiency)?

Answer 9

Utilizing; deficiency;

Increased consumption during metabolism (TPP in PDH);
also it has short half-life (16 days)

Question 10

Re-feeding Syndrome: Prior to initiation of nutrition support, levels of which ions should be checked? When should you check them again? How often?

Answer 10

Na, K, Mg, PO4, Ca

Starting 3-5 days afterward, check them daily (at least)

Question 11

T/F: To prevent re-feeding syndrome, it’s crucial to provide general nutritional support (to provide E) prior to correcting electrolyte/mineral deficiencies.

Answer 11

False! Correct electrolyte/mineral deficiencies first

Question 12

When initiating nutritional support for malnourished patient, providing about (X)% of calorie goal initially will help prevent re-feeding syndrome. Then, gradually increase calorie intake by (Y)% per day.

Answer 12

X = 50
Y = 10-20 max

Question 13

T/F: to prevent/treat re-feeding syndrome, fat emulsions should be used to minimize glucose utilization as main energy substrate.

Answer 13

True

Question 14

T/F: Normal electrolytes prior to initiation of nutritional support essentially guarantees no re-feeding syndrome.

Answer 14

False

Question 15

Re-feeding Syndrome: It’s generally safer to start (enteral/parenteral) nutrition. What’s the difference between those two?

Answer 15

Enteral (via GI tract);

Parenteral means intravenously (bypass GI digestion/absorption)