The whole world in a bottle

Question 1

classic triad refeeding syndrome

Answer 1

malnutrition
disease
alcohol

low
- potassium
- magnesium
- phosphate

(varied drop)

Question 2

who is at risk of refeeding

Answer 2

1 or more:
- BMI <16
- unintentional weight loss >15%
- low levels electrolights
- little or no nutrition

2 or more:
- BMI less than 18.5
- unintentional weight loss greater than 10%
little or no intake 5 days or more
history alcohol abuse or drugs - insulin antacids diuretics

Question 3

refeeding syndrome malnutrition effect on ECF and ICF

Answer 3

cellular uptake potassium PHOS mag decreases in malnutrition

ECF normal or low
ICF - used up during starvation

Question 4

low magnesium side effects

Answer 4

cardiac abnormalities
confusion
delirium
tremors
seizures
wide QRS
T waves
prolonged PR

hypokalaemia
hypocalcaemia

Question 5

treatment or hyperkalaemia

Answer 5

insulin drives potassium into cells

minimal urinary concentration 2-5 mmol (lost even when body potassium deplete)

Question 6

Hypokalaemia side effect

Answer 6

weakness
decreased muscle tone
rhabdomyolysis
ECG - tachy, PR interval, P wave increased, indented T waves

Question 7

phosphate uptake in body

Answer 7

1 mol glucose for 38 mols ATP
when glucose reintroduced massive uptake in phosphate for ATP production

Question 8

implications of hypophosphataemia

Answer 8

seizures
cardiac abnormalities
weakness ilius
increases haemolysis

Question 9

treatment refeeding

Answer 9

diuretics team

reintroduce calories slowly

expect electrolyte redistribution - phophate drops fastest

replace electrolytes IV

give Thiamine

Question 10

Alcoholic ketoacidosis physiology

Answer 10

lipolysis increased - increased levels cortisol, free fatty acids produced , three ketones produced

raised NADH reduces gluconeogenesis

Question 11

treatment

Answer 11

fluids

dextrose slowly

thiamine

correct electrolyte imbalances

alcohol withdrawal protocol

Question 12

Wernicke’s / korsakoffs triad

Answer 12

ataxia
opthalmoplegia
confusion

Question 13

most mitochondrial areas of brain =

Answer 13

higher reason of intelegence within the brain

Question 14

why is thiamine essential - linked to Wernicke’s triad

Answer 14

thiamine cofactor to turn krebbs cycle without it the cycle stalls - switch to anarobic respiration essentially frying your brain

Question 15

Wernicke’s treatment

Answer 15

thiamine

Question 16

how much thiamine is within your liver

Answer 16

roughly 5 -10 days supply thiamine in liver