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Refeeding Syndrome
Refeeding Syndrome
Definition: The metabolic abnormalities that occur upon refeeding a person in a starved
state (Figure 1).
Metabolic consequences include:
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Fluid balance abnormalities
Cardiac failure
Respiratory failure
Neuromuscular failure
Renal failure
Haematological failure
Hepatic failure
Gastrointestinal system failure
REFEEDING
Conversion to glucose as major energy source
Insulin release*
cellular glucose uptake, protein synthesis
Intracellular shifts and extracellular depletion of phosphate, potassium and
magnesium
Chronic alcoholics
Drug abusers
The chronically malnourished (particularly older people)
Patients with anorexia nervosa
Patients with prolonged nil by mouth or fasting times coupled with depletion or
physiological stres.
The risk of an individual patient for refeeding syndrome has been further classified:
Moderate Risk
Patient has one or more of the following:
1. BMI less than 18.5kg/m2
2. Unintentional weight loss greater than 10% within the previous 3-6 months
3. Very little intake for greater than 5 days
High Risk
Patient has one or more of the following:
1.
2.
3.
4.
Replete thiamine
Start feeding at 20 kcal/kg Moderate Risk
Start feeding at 10kcals/kg High Risk
Start feeding at 5kcal/kg
Do not wait for electrolyte blood level to be within normal range before slowly starting feeding
Repeat potassium, magnesium, calcium and phosphate levels 6-12hrs after initiation of
feeding
Monitor potassium, magnesium, phosphate and calcium daily for 1st 3 days or until levels
within normal ranges, then 3 times a week for 2 weeks
MONITORING the severely at risk Restore circulatory volume and monitor fluid
balance and overall clinical status closely. Monitor cardiac rhythm continually in
these patients and any other who develop cardiac arrhythmias (NICE 2006)
Kraft M, Btaiche I and Sacks G. Review of the Refeeding Syndrome Nutr Clin Pract 2005; 20;
625.
Hearing SD. Refeeding syndrome. BMJ 2004; 328: 908-9.