3. Refeeding Syndrome

Question 1

What happens during early starvation?

Answer 1

Glucose levels decline and insulin levels decrease
Glucagon levels increase
Glycogenolysis in liver and lipolysis producing fatty acids and glycerol
Used by tissues for energy and converted to ketone bodies in liver
Gluconeogenesis then stimulated

Question 2

What is the main outcome in starvation?

Answer 2

Body switches the main energy source from carbohydrate to protein and fat, electrolytes are depleted and water and sodium are retained

Question 3

What are the metabolic change to reintroduction of nutrition?

Answer 3

Increased insulin production
Decreased glucagon secretion
Increased cellular uptake of glucose, phosphate, potassium
Reactivation of Na+/K+ membrane pump leads to increased K+ into cells and increased Na+ and fluid loss out of cells
Decreased ability to excrete Na+ and fluid resulting in fluid overload

Question 4

What is the main outcome of reintroduction of nutrition?

Answer 4

Return to carbohydrate metabolism and increased uptake of electrolytes intracellularly resulting in low serum levels

Question 5

What can refeeding syndrome cause?

Answer 5

Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Thiamine deficiency 
Salt and water retention - oedema

Question 6

What are the high risk factors of refeeding syndrome?

Answer 6

Dietary intake very little or none
Low BMI
% weight loss in last 3-6 months
Electrolyte levels low
Alcohol abuse, use of insulin, chemotherapy, antacids or diuretics
Malabsorption (vomiting, diarrhoea)

Question 7

What should be done immediately before and after feeding in refeeding syndrome?

Answer 7

Full dose of IV vitamin B