Stomach Disorders: Refeeding Syndrome

Question 1

What is Refeeding Syndrome?

Answer 1

• The potentially fatal shifts in fluids and electrolytes (from blood to tissues) that may occur in malnourished patients receiving artificial refeeding

Question 2

How does this shift occur?

Answer 2

• Malnourished pt has low insulin due to not eating
• Body secretes glucogon to be converted to glucose (glycogenolysis)
• Body then converts existing proteins (amino acids) to glucose (gluconeogenesis)
• This process results in a depletion of electrolytes, proteins, fats, vitamins and minerals
• When feeding starts, insulin is finally released causing a rapid uptake of glucose, phosphorus, magnesium, potassium and thiamine from blood to tissues leading to low levels of all
• Carbohydrate metabolism of feeding reduces excretion of sodium from renal system leading to fluid retention

Question 3

What does thiamine do for the body?

Answer 3

• Helps to turn food into energy to keep the nervous system healthy.
• The body is not able to make thiamine for itself and will need to be obtained through food

Question 4

How can hypophosphatemia affect the heart?

Answer 4

• It can disrupt myocardial contractility and reduce cardiac function

Question 5

What can low magnesium and potassium levels lead to?

Answer 5

• Heart dysrhythmias

Question 6

What do high sodium levels lead to?

Answer 6

• Fluid retention

* Elevated BP

Question 7

What can low thiamine levels lead to?

Answer 7

• Thiamine deficiency → beriberi disease → heart failure

Question 8

What are the two types of beriberi disease, what does each affect and what can each lead to?

Answer 8

• Wet → heart and circulatory system → cardiac failure

* Dry → damages the nerves → decreased muscle strength and eventually, muscle paralysis

Question 9

Who is at risk for refeeding syndrome?

Answer 9

• Any patient with negligible food intake for more than five days

Question 10

What are some s/s of Refeeding Syndrome?

Answer 10

• “STIMP”
• Seizures
• Tremors
• Irritability and confusion
• Muscle weakness
• Paresthesia (burning, prickly sensation in extremeties)

Question 11

What causes refeeding syndrome?

Answer 11

• Rapid refeeding after a period of under-nutrition

Question 12

How is refeeding syndrome resolved?

Answer 12

• IV electrolytes and vitamin (thiamine, vitamin B1) replacement
• Slow resumption of food when everything is balanced.

Question 13

How can refeeding syndrome be prevented?

Answer 13

• Measure serum electrolyte levels and correct abnormalities before refeeding
• Start feeding slowly to balance out nutrient uptake

Question 14

What are normal Potassium levels?

Answer 14

• 3.5 – 5.0

Question 15

What are normal Phosphorus levels?

Answer 15

• 2.4 – 4.4

Question 16

What are normal Magnesium levels?

Answer 16

• 1.3 - 2.1