Refeeding syndrome

Question 1

What is refeeding syndrome?

Answer 1

A potentially fatal shift in fluid and electrolytes that may occur in malnourished patients once feeding (whether enteral or parenteral) is restarted.

The main biochemical features are hypophosphataemia, hypomagnesaemia and hypokalaemia, as well as abnormal fluid balance

Question 2

Patients are considered high risk of developing refeeding syndrome is any of the following are present:

Answer 2

1. Little nutritional intake >10 days
2. BMI <16 kg/m2
3. Unintentional weight loss greater than 15% over 3-6 months
4. Low potassium, phosphate and magnesium before feeding starts

Question 3

Patients at high risk of refeeding should be started on?

Answer 3

Thiamine of Pabrinex

They require baseline refeeding bloods (magnesium, phosphate, potassium) and checked daily when feeding is commenced, with replacement as needed