Re-feeding syndrome

Question 1

what patients are at risk of re-feeding syndrome?

Answer 1

patients with 1 of the following;

• BMI < 16
• unintentional weight loss > 15% over 3-6 months
• minimal intake in past 10 days
• hypokalaemia, hypomagnesaemia, hypophosphataemia prior to feeding

patients with 2 of the following;

• BMI < 18.5
• unintentional weight loss > 10% over 3-6 months
• minimal intake within last 5 days
• history of insulin, chemotherapy, diuretics or antacid use

Question 2

what are the metabolic abnormalities associated with re-feeding syndrome?

Answer 2

hypophosphataemia
hypomagnaesemia (can lead to torsades de pointes)
hypokalaemia
abnormal fluid balance

Question 3

describe how you would prevent a high risk patient from developing re-feeding syndrome.

Answer 3

start at 10 kcal/kg/day increasing to full needs over 4-7 days 
add thiamine (200-300mg/day), vitamin b co-strong and supplements before and during feeds 
add K (2-4mmol/kg/day), Mg (0.2 - 0.4 mmol/kg/day) and PO4 (0.3-0.6 mmol/kg/day)

Question 4

if a patient hasn’t eaten within the past 5 days how would you prevent referring syndrome?

Answer 4

aim to re-fed < 50% of energy and protein requirements for the first 2 days