Refeeding Syndrome: Pathogenesis and clinical findings



Patients at Risk of Refeeding Syndrome:

 - Little or no nutritional intake in recent past

 - Significant weight loss

 - Low BMI < 18.5 kg/m2

 - Electrolyte disturbances: low K, PO4& Mg prior to feeding

 - History of alcohol abuse or drugs including diuretics, insulin, chemotherapy and or antacids



RAPID REFEEDING ->

  -> Incr glucose, fluid, salt and nutrients from any source; oral, enteral or parenteral

  -> Insulin secretion

 • Incr Na retention -> Fluid overload -> 

   - CHF

   - Pulmonary Edema

   - Cardiac Arrhythmias / Death

 • Incr Glucose Metabolism -> Decr Thiamine 

   - Wernicke-Korsakoff Syndrome

   - Metabolic Acidosis

 • Shift of K, PO4 and Mg into cells -> Decr Serum K, Mg, Ca -> Changes in action potential threshold 

   - Tetany

   - Cardiac Arrhythmias / Death

 • Incr synthesis of proteins -> decr Serum PO4 -> decr RBC ATP + 2,3-DPG -> 

   - hemolysis

   - anemia

   - CNS: Tremors, Ataxia, Coma, Delirium

   - GI: Anorexia, Constipation

   - MSK: Weakness



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