6.10 Refeeding Syndrome

Question 1

Q10 — Refeeding syndrome

a) What is the daily energy requirement of a normal healthy 70kg man?

Answer 1

25-35kcal/kg/day (NICE recommendations).

Question 2

b) What are the recommended daily proportions of carbohydrate, fat and protein?

Answer 2

● Carbohydrates — 50%.

● Fats — 35%.

● Proteins —
0.8-1.5g protein/kg/day
(or 0.13-0.24g nitrogen/kg/day).

Question 3

c) What is refeeding syndrome?

Answer 3

A sudden carbohydrate load after a
little or no nutritional intake for >/=5

days causing severe electrolyte abnormalities

(due to the intracellular movement of phosphates,
fluids and electrolytes).

Question 4

d) What are the three major electrolyte abnormalities seen in
refeeding syndrome?

Answer 4

● Hypophosphataemia.

● Hypokalaemia.**

● Hypomagnesaemia.

Question 5

e) What is the commonest electrolyte nutritional deficiency?

Answer 5

Hypophosphataemia.

Question 6

f) Which patients are at particular risk of refeeding syndrome?

Answer 6

● Patients who abuse alcohol.`

● Chronically undernourished patients.

● Patients on diuretics.

● Patients on chemotherapy.

● Patients on insulin.

● Patients on antacids.

● Critically ill patients with no or minimal intake for >5 days.

Question 7

g) How should the nutritional requirements of those ‘at risk’ be
managed?

Answer 7

● Identify the patients at risk of refeeding syndrome.

● For the first 2 days, commence nutritional support at 50% of
estimated energy requirements in this at-risk group of patients.

● Increase by 200-400kcal every day thereafter.

● Electrolytes and micronutrients to accompany nutrition and fluids.

● Close monitoring and correction of serum electrolytes — potassium, magnesium, phosphate after feeding is started.