Refeeding syndrome

Question 1

What is refeeding syndrome?

Answer 1

Life-threatening metabolic complication from refeeding through any route after a prolonged period of starvation

Question 2

What is the pathophysiology of refeeding syndrome?

Answer 2

↓ carbs: catabolic state causing ↓insulin, fat and protein

Catabolism and depletion of intracellular PO4

Refeeding: ↑ insulin in response to carbs (rebound increase) and ↑ cellular PO4 uptake

Question 3

What are the biochemical changes in refeeding syndrome?

Answer 3

Low K
Low Mg
Low PO4
Abnormal fluid balance

Question 4

What are the features of refeeding syndrome?

Answer 4

Hypophosphataemia (RRAS)

• Rhabdomyolysis
• Respiratory insufficiency
• Arrhythmias
• Shock
• Seizures

Question 5

Which sort of patients are at risk of refeeding syndrome?

Answer 5

Patients are considered high-risk if one or more of the following:

BMI < 16 kg/m2
unintentional weight loss >15% over 3-6 months
little nutritional intake > 10 days
hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)

If two or more of the following:

BMI < 18.5 kg/m2
unintentional weight loss > 10% over 3-6 months
little nutritional intake > 5 days
history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

In summary:

1) Malignancy
2) Anorexia nervosa
3) Alcoholism
4) GI surgery
5) Starvation

Question 6

Prevention and treatment of refeeding syndrome?

Answer 6

Prevention: Identify at risk patients. Liaise with a dietician
Treatment:
- Potassium, phosphate and magnesium replacement i.e polyfusor
- Oral thiamine as well.

Question 7

Any guidance on feeding in patients who are malnourished?

Answer 7

NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.