Refeeding Syndrome Flashcards
who is at risk of refeeding syndrome?
BMI below 16 and little to eat in past 10 days, drug and alcohol use, weight loss greater than 15%
what do starved cells do when someone starts refeeding?
use up magnesium, potassium and phosphorus.
Hence hypomagnesaemia, hypokalaemia, hypophosphataemia
what are patients with refeeding syndromes at risk of?
arrhythmias, fluid overload and heart failure
how to manage refeeding syndrome?
slowly reintroduce food with restricted calories
monitor Mg (0.2mmol) , K (2-4mmol) And P (0.3-0.6mmol) and glucose (6 hourly)
fluid balance montoring
ECG monitoring
supplementation electrolytes vits B and thiamine
presentation?
nausea, weakness, cardiac arrest
pathophysiology of refeeding syndrome?
in starved state insulin drops and you get gluconeogenesis and vitamins are depleted. when you refeed blood glucose levels increase and you get an insulin spike. Vitamins and electrolytes move into cells and so lblood contains low levels
clinical features of vitamin and electrolyte deficiency?
low thiamine- wernicke and korsakoff
low phosphate- muscle weakness/ rhabdomyolysis, paraesthesia and seizures, and arrhytmias
low Mg-
Low K- weakness in lower limbs and t wave flattening and u waves arrhythmias
wernicke triad
confusion
opthalmoplegia (weakness of eye muscles)
ataxia
korsakoff features
psychosis
amnesia
confabulations
hypomagnesaemia may predispose to?
torsades de pointes