What is it?
May occur when a pt begins eating an adequate amount – oral, EN or PN - after a period of prelonged starvation or malnutrition |
1. Starvation Phase: ↓ insulin secretion, ↑ fat and protein metabolism, ↓ Phosphate, K, Mg stores depleted (serum levels may be normal) |
2. Refeeding Phase: Sudden increase in carbohydrate intake → ↑ insulin secretion. Rapid intracellular shift causes ↓ serum electrolyte levels. |
At risk
BMI <18.5, 10% weight loss 3-6/12, little/no intake >5 days, ↓ K, Mg, PO |
chronic malnutrition |
chronic alcoholism/substance abuse |
EDs |
oncology |
post-op |
severe mental health disorders |
S/S
Water/salt retention (oedema) |
Impaired muscle contraction, |
tachy/brady |
glucose intolerance |
respiratory difficulties |
seizures |
confusion |
coma |
blurred vision |
Biochem
↓ serum K |
↓ serum PO |
↓ serum Mg |
↓ thiamine (B1) |
|
|
Consequences
Electrolyte imbalances (hypophosphataemia, hypokalaemia, hypomagnesaemia) |
Abnormal glucose metabolism - hypoglycaemia or hyperglycaemia |
Thiamine deficiency |
Cardiac: arrhythmias, heart failure |
Respiratory: muscle weakness, respiratory failure |
Neurologic: confusion, seizures |
Haematologic: anaemia, impaired immune function |
Intervention
Initiate feeding once: 1. RFS Supps (PO4, K, Mg, B1) have commenced. 2. Electrolytes are monitored. 3. Abnormalities are corrected |
High risk pts: Start rate = 50% of goal OR Commence low-CHO feed @ ~6000kJ/day. Increase by 2000kJ/day until goal is met. |
Lower risk pts: Start @ 1800kcal/day. Gradually increase when biochem is stable, eg +400cal/week |
Avoid excessive Na (water retention) |
NGT - BMI <14kg/m2 |
Sup 500mg PO4 bd. 100mg thiamine od for first week. |
|
|
Guidelines & References
Handbook p169 |
ASPEN consensus recommendations for refeeding syndrome (2020) |
ESPEN basics in clinical nutrition: Refeeding syndrome (2010) |
Monitoring
Monitor weight daily |
Electrolytes 6-8 hours after first re-feeding |
Daily bloods for the first week |
Second week = bloods 3/week |
BGL 2/day |
|
