refeeding article Flashcards
minor risk factors?
BMI <18.5, unintentional wt loss >10% past 3-6 months, little/no nutr intake for >5 days, hx alcohol/drugs
major risk factors?
BMI <16, unintentional wt loss >15% past 3-6 months, little/no nutr intake for >10d, low baseline lvl K/P/Mg
specific pt populations to assess risk:
chronic severe dieting, hunger strike, hx bariatric surgery, SBS, tumour, frail elderly
low risk is ____, high risk is ____
1 minor risk factor; 1 major or 2 minor risk factors
what is very high risk?
BMI <14, wt loss >20%, starvation >15d
if low risk, provide energy as ___kcal/kg/d, if high risk ___kcal/kg/d
15-25; 10-15
if very high risk, provide ___kcal/kg/d
5-10
restrict Na intake in ____ risk refeeding
high and very high
diagnose if shift in electrolytes within 72h show:
decrease of P from baseline >30% or <0.6mmol/L, or any other 2 electrolyte shifts below normal
if see electrolyte shifts but no clinical symptoms, call this ____ RFS
imminent
if shift in electrolyte and also clinical symptoms, call this ___ RFS
manifest
in low risk, bring to goal rate by day ___, if high risk by day ___, and if very high by day ___
4; 6; 10
RFS is ___ reaction caused by nutr therapy and associated with ____ resulting from metabolic changes and fluid imbalance
anabolic; serum electrolyte shifts and clinical symptoms
RFS first described in ____
prisoners liberated from concentration camps
why not include anorexia nervosa?
believed to have diff pathophysio perspective
role of phosphate?
intracell metabolism of macros and major component of enzymatic cofator, second messengers, and reg processes
magnesium role?
maintaining neuromuscular and enzymatic fxn
___ is retained even during catabolic situations
sodium
why hypokalemia occur?
rapid cell uptake of K as gluc and a.a. taken up during cell synthesis of glyco and protein
why hypophosphatemia?
increased phosphorylation of gluc and other high energy phosphorylated molecules
nutr rich in ____ and ___ may reduce serum phosphate
Ca and CHO (Ca is binder, CHO leads to intracell shift of P cuz of insulin ^)
Na and water retention aggravated by _____
preexisting pathology of heart or thiamin deficiency
severe nutr depletion, atrophy of gut mucosa and impairment of pancreatic fxn predispose to severe ____
diarrhea
v Mg and K cause ____
heart arrhythmia
Na retention further aggravated by ^ ___ and resulting extracell fluid expansion
insulin
main symptoms of RFS:
tachycardia, tachypnea, peripheral edema
prophylactic admin of _______ in pt at risk of RFS effective
phosphate and thiamine
main criterion for RFS
hypophosphatemia
