Refeeding Syndrome Flashcards
In starvation, once Glycogenolysis is not sustainable due to Glycogen stores being depleted, what happens?
Gluconeogenesis stimulated in liver to make Glucose using;
- Amino Acids
- Lactae
- Glycerol
During starvation, the body minimises the action of energy consuming pathways, including cellular pumps, allowing electrolytes to leak across membranes.
What happens to;
- Electrolytes (K, Ca, Mg)
- Na and H20
- Cardiac, Intestinal and Renal function
- Electrolytes move from cells into plasma, and are excreted by kidneys-> Deficits
- Na + H20 leak into cells
- Impaired Cardiac/ Intestinal/ Renal functions-> Reduced ability to excrete excess Na and H20
Upon refeeding, the body switches to anabolism.
Describe what this results in
- Carbs are, once again the major energy source
- Insulin secretion stimulates cellular uptake of protein and glycogen synthesis
- Results in increased uptake of Glucose, K, Mg, and Po4, as well as increased Thiamine utilisation
Results in Refeeding Syndrome;
- Hypokalaemia
- Hypomagnesaemia
- Hypophosphataemia
- Thiamine deficiency
- Salt and water retention-> Oedema
What can Refeeding Syndrome lead to if untreated?
Death
List 6 signs of a patient being at risk of Refeeding Syndrome
Patients with 1 or more of;
- Poor diet intake (little/ no food for >5 days)
- Low BMI
- Unintentional weight loss in 3 to 6 months
- Low electrolyte levels
- Alcohol abuse, use of insulin/ chemo/ diuretics
- Malabsorption
What are the main 3 markers to monitor in a patient at risk of refeeding syndrome
- K+
- PO4 3-
- Mg2+
What do you do when you identify a patient at risk of refeeding syndrome
Refer to dietician for safe refeeding
Start at 10cal/kg/ day, 5cal in extreme cases
What are 6 things to consider alongside refeeding
- Daily IV Vit B before and during feeding
- Balanced multivitamin supplement daily
- Electrolyte replacement
- Monitor cardiac rhythm
- Restore circulatory volume (e.g fluid requirements)
- Monitor fluid balance/ fluid chart
