Lecture 9 Flashcards
potentially fatal shifts in fluid/lytes that can occur in malnourished pt after start of nutr therapy
refeeding syndrome
RFS is characterized by:
hypophosphatemia, hypokalemia, hypomagnesaemia, changes in gluc/pro/fat metabolism, thiamine deficiency
etiology of RFS?
response to aggressive feeding after prolonged fasting/starvation, switch from catabolic to anabolic state
response to feeding after prolonged starvation:
^ BMR, rapid cell uptake of K (serum v), ^ ATP synth, phosphorylation (serum P+Mg+thiamine v), Na and water retention (edema)
high P could be indicative of ____
cell lysis
fxn of P
intracell mineral, cell mem integrity, ATP, regulate O2 delivery, renal acid base buffer system
signs of acute hypophosphatemia
resp insufficiency, v cardio output, rhabdomyolysis, arrhythmia, altered mental state, seizure, hemolysis, impaired hepatic fxn
fxn of K:
integral to normal cell fxn, tightly regulated by ATP-ase pumps
signs of hypokalemia:
resp depression, delirium, hallucinations, cardiac arrhythmias,musc cramps, neuromusc dysfunction
fxn of Mg
cofactor in oxidative phosphorylation and ATP production, necessary for structural integrity of DNA/RNA
signs of hypomagnesemia
cardiac arrhythmia, neuromusc dysfunction, hypertension, neuropsychiatric disturbance
fxn of thiamine
essential coenzyme in CHO metabolism
signs of thiamine deficiency:
wernicke’s encephalopathy (ocular abnormalities, ataxia, confusion, hypothermia, coma), korsakoff’s syndrome (memory disturbed), alcoholism
clinical symptoms of RFS:
tachycardia, tachypnea, edema in limbs and heart
treating rfs?
calorie reduced target, electrolyte supplementation
