Refeeding syndrome
Refeeding of severely malnourished patients may result in "refeeding syndrome" in which there are acute decreases in circulating levels of potassium, magnesium, and phosphate.
The sequelae of refeeding syndrome adversely affect nearly every organ system and include cardiac dysrhythmias, heart failure, acute respiratory failure, coma, paralysis, nephropathy, and liver dysfunction.
The primary cause of the metabolic response to refeeding is the shift from stored body fat to carbohydrate as the primary fuel source.
Serum insulin levels rise, causing intracellular movement of electrolytes for use in metabolism.
The best advice when initiating nutritional support is to "start low and go slow".
Recommendations to reduce the risk of refeeding syndrome include:
- Recognize patients at risk
- Anorexia nervosa
- Classic kwashiorkor or marasmus
- Chronic malnutrition
- Chronic alcoholism
- Prolonged fasting
- Prolonged IV hydration
- Significant stress and depletion
- Correct electrolyte abnormalities before starting nutritional support
- Administer volume and energy slowly
- Monitor pulse, I/O, electrolytes closely
- Provide appropriate vitamin supplementation
- Avoid overfeeding
