30/10/2021
REFEEDING SYNDROME
Refeeding Syndrome denotes the metabolic condition that occurs when previously starved individuals are given nutrition.
Refeeding syndrome usually occurs within four days of starting to feed
A. EFFECTS
1. FLUID & ELECTROLYTE DISORDERS,
- Low Phosphate, low Magnesium, low Potassium
2. CARDIAC COMPLICATIONS
-Cardiac arrhythmias are the most common cause of death from refeeding syndrome,
- Cardiac Failure,
3. NEUROLOGICAL
- confusion, coma and convulsions
This happens when feeds are commenced too rapidly.
Refeeding syndrome usually occurs within four days of starting to feed
It can be FATAL if it is not recognised and treated properly
B. AT RISK
1. Anorexia Nervosa
2. Depressed elderly
3. Vagrants
4. Homeless
5. Diabetics on insulin
6. Alcoholics
7. Hunger strike
8. Chronic diuretic or antacid abuse
C, PATHOPHYSIOLOGY
1. During prolonged fasting
The body conserves muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source.
The liver decreases its rate of gluconeogenesis thus conserving muscle and protein.
Many intracellular minerals become severely depleted during this period, although serum levels remain normal.
Importantly, insulin secretion is suppressed in this fasted state and glucagon secretion is increased.
2, REFEEDING
During refeeding, insulin secretion resumes in response to increased glycemia; resulting in increased glycogen, fat and protein synthesis.
This process requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up.
THE ANABOLIC REACTIONS OF INSULIN CAUSES UPTAKE OF PHOSPHATE MAGNESIUM & POTASSIUM
THIS RESULTS IN THEIR DEPLETION IN PLASMA
PHOSPHATE is needed for ATP production
The shifting of electrolytes, low plasma phosphate and disrupted fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure.
Refeeding also increases the basal metabolic rate.
Glucose, and levels of the B vitamin thiamine may also fall.
Oxygen consumption is also increased which strains the respiratory system and can make weaning from ventilation more difficult.
Cardiac arrhythmias are the most common cause of death from refeeding syndrome,
D. TREATMENT
1. Monitoring of blood biochemistry
2. Energy intake should remain only 50-70% that of normally required for the first 3–5 days.
3. Milk is often the refeeding food of choice in this early period as it is naturally high in PHOSPHATE and easily tolerated by those who have been starved.
4. If potassium, phosphate or magnesium are low then this should be corrected via the oral route, or if severe with parenteral treatment.
5. Prescribing thiamine, vitamin B complex (strong) and a multivitamin and mineral is recommended. Biochemistry should be monitored regularly until it is stable.
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