Week 3 Refeeding Syndrome Flashcards
Define Refeeding Syndrome
Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished (with/without cachexia) or metabolically stressed due to severe illness.
Risk factors for RFS in clinical practice
- Patients who have gone for prolonged periods of little to no nutritional support where they have lost significant amounts of weight (may or may not be underweight)
- And/or patients who have a syndrome associated with elevated resting energy expenditure (e.g cancer cachexia, burns) who may or may not have lost weight.
Examples of clinical populations who may experience refeeding syndrome
- short gut
- eating disorders
- some cancers (e.g lung)
- and/or conditions of hypermetabolism (e.g burns, short gut, end-stage liver failure). Usually this would could with weight loss but this is not the sole criteria.
- It could also be when patients have had very low amounts of oral and/or nutritional support for pro-longer periods.
pathophysiology of refeeding syndrome
What can refeeding syndrome lead to?
This can lead to abnormalities in neurologic, cardiac, hematologic, neuromuscular and pulmonary function; people have died from this.
What are signs for risk of refeeding syndrome?
- Hypophosphatemia
- Hypokalemia
- Hypomagnesemia
- Vitamin/Thiamin Deficiency
- Fluid and Sodium Retention
What happens when CHO introduced to someone who has not eat for a long time?
When introduce CHO → insulin is released → get uptake of phosphate, magnesium (Mg) and potassium (K+) into cells
What are phosphate and magnesium important for?
Both are important for ATP generation from glycolysis
What phosphate levels indicate risk for RFS?
- Hypophosphatemia < 0.74 mmol/L indicates the patient is likely to get re-feeding syndrome in response to refeeding the patient.
- Levels of phosphorus between 0.75-0.9 mmol/L and potassium values < 3.5 mmol/L in patients who fit the other criteria for refeeding risk, indicate that these patients are at very high risk for developing refeeding syndrome.
- Normal phosphate is 1.1-1.8 mmol/L (up to 2 in children)
Clinical manifestations of hypophosphatemia
memory loss, bone pain, bruising, bleeding, lethargy, joint stiffness, arthritis, cyanosis, decreased cardiac output, respiratory failure, seizure, coma, death
Monitoring phosphorous levels
Monitor levels daily with refeeding and supplement with either oral or IV phosphate (depends on severity of hypophoshatemia)
* often when serum levels below 0.7 mmol/L; need IV source in doses ranging from 0.16-0.32 mmol/kg over 6 hours).
Clinical Manifestations of Hypokalemia
Nausea, vomiting, constipation, weakness, paralysis, respiratory compromise, muscle necrosis, myocardial contraction problems, cardiac arrythmias, bradycardia and atrial tacchycardia, ventricular fibrillation and sudden death
Serum levels of potassium
- Normal serum levels: 3.5-5 mmol/L (slightly higher for children)
- Hypokalemia < 3.5 mmol/L (in children < 3.6 mmol/L)
- Important to monitor serum levels q daily if levels less than 3.0 mmol/L during re-feeding
Supplementing potassium
- May need to supplement with oral potassium in the range of 0.5 mmol/kg/d (MD to prescribe)
- Typically in forms of KCL, or K-citrate
- May need to supplement IV route if serum levels < 2.5 mmol/L (note this is done by MD)
Problem with potassium supplementation
Potassium tends to be gastric irritant