Refeeding Syndrome Overview



What Is It?

	• Electrolyte/fluid shifts caused by initiation of nutrition in severely malnourished patient. This can be fatal.

	• These shifts result from hormonal and metabolic changes and may cause severe clinical complications.



Risk Factors:

	• Poor/minimal intake for >7 days

	• Significant weight loss

	• History of excessive alcohol intake

	• Malnutrition due to chronic disease/malabsorptive conditions

	• Anorexia nervosa

	• Persistent N/V/D

	• Poorly controlled diabetes

	• Oncological conditions

	• Post-operative state



Characterized By:

Early:

	• Hypo-Phos

	• Hypo-K

	• Hypo-Mg2+

	• Vitamin deficiency (thiamine)

Late:

	• Cardiac decompensation (CHF)

	• Respiratory failure (volume overload)

Other Symptoms:

	• N/V

	• Palpitations

	• Diarrhea

	• Tremors

	• Paresthesias

	• Rhabdomyolysis

	• Seizures

	• Hemolysis

	• Delirium



DDX:

	• Congestive heart failure

	• Epilepsy

	• Fanconi syndrome

	• Tumor-induced osteomalacia

	• Intestinal malabsorption

	• Nephrotic syndrome

	• Wernicke encephalopathy

	• Pellagra

	• Vitamin D deficiency

	• Primary hyperparathyroidism

	• Secondary hyperparathyroidism



Treatment/Prevention:

	• Monitoring and correction of electrolyte abnormalities before refeeding (Phos, K, Mg2+)

	• Slow initial feeding

	• Monitor on telemetry for arrhythmias

	• Thiamine before initiation of feeding

	• Arrhythmias are the leading cause of death

	• Stop feeding if electrolyte abnormalities persist



#Refeeding #Syndrome #Nutrition #Differential #Diagnosis #Pathophysiology