Part two - nutrition

Question 1

Define refeeding syndrome

Answer 1

Potentially fatal fluid and electrolyte shifts that may occur in malnourished patients receiving artificial feeding.

Hallmark is hypophosphataemia.

May also feature abnormal sodium and fluid balance; changes in glucose, protein and fat metabolism, thiamine deficiency; hypokalaemia; and hypomagnesaemia.

Question 2

Pathophysiology of referring syndrome

Answer 2

Insulin is secreted on feeding

Insulin stimulates glycogen, fat and protein synthesis

Requires phosphate, magnesium and thiamine

Resultant depletion of serum levels in the context of total body depletion

Question 3

Sequelae of hypophosphataemia

Answer 3

Arrhythmia
Congestive heart failure
Cardiomyopathy
Reduced cardiac contractility
Hyper- or hypotension
Sudden death
Respiratory failure
Weakness
Paraesthesiae
Altered mental state
Paralysis

Question 4

Who is at risk of refeeding syndrome?

Answer 4

Any patient with negligible food intake for more than five days

High risk patients:

• Anorexics
• Alcoholics
• Oncology patients
• Post-operative patients
• Elderly comorbid patients
• Uncontrolled diabetics

Question 5

Definition of short bowel syndrome

Answer 5

Malabsorptive state following massive resection of the small bowel

Question 6

Treatment principles of short bowel syndrome

Answer 6

• MDT approach
  
  • Maintain nutritional status
  • Maximise enteral nutritional absorption
    
    • Surgical rehabilitation
      - longitudinal enteroplasty
      - STEP procedure
  • Prevent complications
  • Consider transplantation

Question 7

How much small bowel is required for normal function?

Answer 7

100cm if no colon

50cm if colon present