Refeeding syndrome- Nutrition Flashcards
Risk factors
Alcohol use disorder
significant unplanned weightloss (>10% in less than 6 months)
Low BMI
Low levels of Phos, K, and Mag prior to feeding
clinical findings electrolytes
Hypophosphatemia, phypomagnesemia, hypokalemia
Normal Phos range
2.5-4.5mg/dL
Normal Magnesium range
1.5 to 2.5 mg/dL
Normal potassium levels
3.5-5mEq/L
Prevention - patient comes in and is at risk of refeeding this is what you should do before initiation feed and while initiating feed
REPLETE Electrolytes before initiating feed!!!
- Initiate feed at 50% of total caloric need and titrate up as tolerated
- Give thiamine 100mg daily for 5-7 days
Want to limit carbs to 100-150mg and limit fluid to around 800ml/day
Phos, Mg, and K levels we want in ICU specifically
K >4
P>3
Mg>2
TW is a 56 yom that was found down after being outside for several hours in the cold. The patient has suffered frostbite and was intubated in the ED for airway protection. Patient is found to have a perforated small bowel, requiring emergent surgery. He has now developed an ileus post-operatively. The team would like to start PN.
Significant for HTN, psychosis, and COPD. Patient is experiencing homelessness. Report from the ED prior to intubation states that patient reported drinking on average 5-6 beers and 1⁄2 pint of Johnny Walker per day. Does not smoke or use illicit drugs. He reported an approximate 20-pound weight loss over the past several months. [Ht: 67 in; Wt: 64 kg]
What are the next steps for this patient
A. Start Clinimix E at a rate of 100ml/hr
B. Start TPN at 100ml/hr
C. replenish electrolytes before starting PN
D. Patient should not start PN and should be placed on EN
C is the correct answer because the patient has multiple risk facts for refeeding syndrome
- AUD, significant weight loss, low electrolyte levels
- Patients electrolytes are lower than K >4, Phos >3 and Mg > 2
need to get electrolytes up then start TPN
