Refeeding syndrome

Question 1

What is refeeding syndrome?

Answer 1

Refeeding syndrome is defined as medical complications that result from fluid and electrolyte shifts as a result of aggressive nutritional rehabilitation.

Question 2

What electrolyte imbalances occur in refeeding syndrome?

Answer 2

hypoMg
HypoK
Hypophosphate

thiamine deficiency

+ salt/water retention > edema

Question 3

What are the risk factors for refeeding syndrome?

Answer 3

1. Low BMI < 16-18.5
2. No/poor oral intake for > 5-10 days
3. unintentional weight loss > 10-15% within the last 3-6 months
4. low levels of K, phopshate or Mg before feeding
5. hx of alcohol abuse, or drugs (insulin, chemotx, antacids, or diuretics)

Question 4

What is the recommended nutritional intake?

Answer 4

25-35 kcal/kg/day total energy
0.8-1.5g protein/day
30-35ml fluids/kg
+ adequate electrolytes, minerals, micronutrients

Question 5

How to re-introduce nutrition to pt with refeeding syndrome?

Answer 5

1. BEFORE refeeding starts & during the first 10 days of feeding:
   administer PO thiamine 100mg BD-TDS (can be IV) + Neurobion 1 tab BD-TDS + Multivit 1 tab OM
2. pt with no/little food intake for > 5 days should have nutrition support introduced at no more than 50% of the requirements for the first.2 days, before increasing feed rates to meet full needs over 4-7 days
3. Plus correct levels of:
   - K (2-4mmol/kg/day)
   - Phosphate (0.3-0.6 mmol/kg/day)
   - Mg (IV 0.2 mmol/kg/day, PO 0.4mmol/kg/day)