Refeeding Syndrome

Question 1

Starvation

Answer 1

Glycogenesis maintains glucose levels
F.A oxidation -> ketone bodies
Electrolytes move OUT of cells but homeostatic mechanism maintains serum conc and so levels appear normal
Loss fat + protein -> organ atrophy

Question 2

Triggers

Answer 2

Switch fat -> CHO metabolism
Increased insulin release
Increased uptake gluc, PO, K, Mg, H20 INTO cells
Synthesis lean tissue

Question 3

Leads to

Answer 3

Fluid retention (oedema)
Decreased serum electrolytes
Vitamin deficiency

Question 4

Consequences low Ph

Answer 4

Liver dysfunction
Seizures
Paralysis
WBC dysfunction
Hypoventilation
Altered myocardial function

Question 5

NICE high risk criteria

Answer 5

BMI <16kg/m2
Unintentional w loss >15% in 3-6m
Little/no intake >10days
Low Ph, Mg, K prior to feeding

Question 6

Prevention / management

Answer 6

Slow introduction of nutrition
Restore circulatory volume
Before/during first 10d - thiamine, vit B and multivitamins
Supplementation of K, Mg, Ph

Question 7

Refeeding regimen

Answer 7

1 - 10kcal
2-4 - 15kcal
5-7 - 20-30kcal
8-10 - 30kcal

Full fluid, electrolytes, vitamins from outset

Question 8

Clinical monitoring

Answer 8

Early identification of high risk pt
B.p and pulse rate
Feeding rate
Change in body weight
Patient education

Question 9

Biochemical monitoring

Answer 9

Blood glucose levels

Electrolyte levels