Refeeding Syndrome

Question 1

Refeeding Syndrome

Answer 1

Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person following a period of starvation. The metabolic consequences include:
hypophosphataemia
hypokalaemia
hypomagnesaemia
abnormal fluid balance

These abnormalities can lead to organ failure.

Question 2

Refeeding Syndrome - Prevention

Answer 2

Prevention

NICE produced guidelines in 2006 on nutritional support. Refeeding syndrome may avoided by identifying patients at a high-risk of developing refeeding syndrome:

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

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.

Question 3

Refeeding Syndrome - Example Question

Answer 3

A recovering alcoholic patient on the ward has developed confusion two days after admission to hospital. In addition he reports difficulty standing up from sitting and increasing shortness of breath.

Further questioning reveals he normally drinks 5-6 pints of medium strength lager most days but his last drink was 7 days ago. His diet is poor. He smokes 30 rolled up cigarettes per day. On examination it is noted his chest is clear but he he has generalised muscle weakness. What investigation will most likely reveal the underlying abnormality?

	CT brain
	Full blood count
	> Urea and electrolytes, including phosphate and magnesium
	Muscle biopsy
	Electromyography (EMG)

Alcoholic patients are often malnourished. In hospital the patient has (hopefully!) no access to alcohol but also three meals a day provided. Re-feeding syndrome is the only condition responsible for the above symptoms that can be readily diagnosed from the above tests. Blood tests will reveal electrolyte disturbances particularly hypophsphataemia accompanying the neurological and pulmonary manifestations. Treatment involves replacing the depleted electrolytes and slow build up of diet.