Refeeding Syndrome

Question 1

What is refeeding syndrome?

Answer 1

An imbalance of electrolytes that is potentially fatal when a severely malnourished patient begins to reintroduce food

Question 2

What electrolyte abnormalities are seen in refeeding syndrome?

Answer 2

Low phosphate
Low potassium
Low magnesium
Hyperglycaemia

Question 3

What symptoms can low phosphate cause?

Answer 3

Muscle weakness
Respiratory failure
Delirium
Seizures

Question 4

What symptoms can low magnesium cause?

Answer 4

Neuromuscular excitability
Muscle weakness
Cardiac arrhythmias

Question 5

What symptoms can low potassium cause?

Answer 5

Muscle weakness
Paralysis
Potentially fatal cardiac arrhythmias

Question 6

What symptoms can hyperglycaemia cause?

Answer 6

Polyuria
Polydipsia
Fatigue
Blurred vision

Question 7

What is the management of refeeding syndrome?

Answer 7

Monitoring of potassium, magnesium and phosphate levels
Slow reintroduction of food
Thiamine replacement for at risk patients to prevent Wernicke’s encephalopathy

Question 8

Why does refeeding syndrome occur?

Answer 8

In starvation mode, circulating insulin levels drop, and intracellular phosphate is depleted

When refeeding occurs, insulin levels suddenly rise, and phosphate is taken up into cells