Refeeding syndrome

Question 1

Definition

Answer 1

potentially fatal shifts in fluids and electrolytes following refeeding after a period of malnutrition

Question 2

Summary of the fed and fasted states

Answer 2

• Fasted: insulin low, glucagon high, gluconeogenesis, glycogenolysis, protein and fat breakdown. Low BMR
• Fed: insulin raises, glucose pumped inot cells. Na pumped out of cells, and K and Mg pumped in (abhorrent electrolyte state). Cells rapidly take up K, Mg, thiamine (lowers in serum) can lead to respiratory and cardiac failure. Arrhythmia and death (low phosphate), low thiamine (WE, KP), fluid shifts (Na, K)

Question 3

High risk groups for developing RFS

Answer 3

• very high risk: BMI <14, no intake for 15 + days
• high risk, 1 of the following: BMI <16, no intake for 10+ days, 15% WL in 3-6 months
• high risk, 2 of the following: BMI <18.5, no intake for 5+ days, 10% WL in 3-6 months

Question 4

Prevalence of malnutrition in population, hospital and institutionalised

Answer 4

• overall: 3 million with or at risk of malnutrition
• hospital: 30-50%
• institutionalised: 25-60%

Question 5

NICE management for RFS

Answer 5

• for everyone: thiamine 200-300mg + vitamin B complex TDS for 10 days, Pabrinex IV 10 days, multivit and trace element for 10 days, 2-3 mmol/kg/day K, 0.3-0.6 mmol/kg/day PO4, 0.2 mmol/kg/day Mg
• most: 10 kcal/kg/day to full requirements in 4-7 days
• high risk: 5 kcal/kg/day to full requirements in 7 days

Question 6

MARSIPAN guidance for anorexia nervosa

Answer 6

• need ED specialist dietician and psychiatrist in MDT
• need to ensure no underfeeding, RFS
• manage behavioural and family issues
• arrange transfer to specialist unit ASAP
• treat under section 3 if needed