Nutrition in surgery patients and refeeding syndrome Flashcards
What is refeeding syndrome?
Life-threatening metabolic complication of refeeding via any route after prolonged period of starvation
What patients are most at risk of refeeding syndrome?
- Eneteral/Parenteral feeding after prolonged starvation
- Anorexia nervosa
- Alcoholism
How does refeeding syndrome occur?
AS body turns to fat and protein metabolism in starved state, there is a drop in the level of circulating insulin. The catabolic state also depletes intracellular phosphate stores (serum levels may remain normal).
When refeeding begins, the level of insulin rises in response to carbohydrates being present, resulting in cellular uptake of phosphate, leading to hypophosphataemia within about 4 days of eating.
What are features of refeeding syndrome?
- Rhabdomyolysis
- RBC/WCC dysfunction
- Respiratory insufficiency
- Arrhythmias
- Cardogenic shock
- Seizures
- Sudden death
- Fluid retention
- Metabolic disturbance - hypokalaemia, hypophosphataemia, hypomagnasaemia
Why does respiratory insufficiency occur in refeeding syndrome?
Lack of phosphate can lead to muscle weakness, which can result in diaphragmatic insufficiency
What is the most common cause of death in someone with refeeding syndrome?
Cardiac arryhtmias
Why can someone develop HF in refeeding syndrome?
Shifting of electrolytes and fluid balance increases cardiac workload and heart rate
How would you monitor for refeeding syndrome?
- Food intake chart
- Bloods - Lipids, Glucose, U+E’s
What electrolytes would you want to keep a particular eye on in someone at risk of re-feeding syndrome?
- Na+
- K+
- Phophate
- Calcium
- Mg2+
- Zinc
How would you try to prevent refeeding syndrome?
- Monitoring
- High-dose pabrinex in refeeding window
- Consider Parenteral phosphate administration
What are general rules for eating and drinking before elective surgery?
- Water/Clear fluids - up to 2 hrs before
- All other intake - up to 6 hours before
What are the general rules for fasting prior to emergency surgery?
>/= 6hrs prior to theatre - may not be possible
What tool might you use to identify patients who are nutritionally at risk?
MUST scoring system
What are examples of enteral feeding routes?
- By mouth
- NG tube
- PEG tube
What is parenteral nutrtion?
Feeding someone intravenously, bypassing the usual process of eating and digestion
