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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
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% Document Info
\author{Michellephillips02}
\pdfinfo{
  /Title (refeeding-syndrome.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (Refeeding Syndrome Cheat Sheet)
}

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% Header and Footer
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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Refeeding Syndrome Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46707/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
  \end{tabulary}
\vfill
\columnbreak
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th July, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{What is it?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{May occur when a pt begins eating an adequate amount – oral, EN or PN - after a period of prelonged starvation or malnutrition}}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{1. {\bf{Starvation Phase}}: ↓ insulin secretion, ↑ fat and protein metabolism, ↓ Phosphate, K, Mg stores depleted (serum levels may be normal)} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{2. {\bf{Refeeding Phase}}: Sudden increase in carbohydrate intake → ↑ insulin secretion. Rapid intracellular shift causes ↓ serum electrolyte levels.} \tn 
% Row Count 10 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.84149 cm} x{3.13551 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{At risk}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{BMI \textless{}18.5, 10\% weight loss 3-6/12, little/no intake \textgreater{}5 days, ↓ K, Mg, PO}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
chronic malnutrition & chronic alcoholism/substance abuse \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
EDs & oncology \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
post-op & severe mental health disorders \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.53827 cm} x{2.43873 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{S/S}}  \tn
% Row 0
\SetRowColor{LightBackground}
Water/salt retention (oedema) & Impaired muscle contraction, \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
tachy/brady & glucose intolerance \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
respiratory difficulties & seizures \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
confusion & coma \tn 
% Row Count 6 (+ 1)
% Row 4
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\mymulticolumn{2}{x{5.377cm}}{blurred vision} \tn 
% Row Count 7 (+ 1)
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\par\addvspace{1.3em}

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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Biochem}}  \tn
% Row 0
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↓ serum K & ↓ serum PO \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
↓ serum Mg & ↓ thiamine (B1) \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Consequences}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Electrolyte imbalances (hypophosphataemia, hypokalaemia, hypomagnesaemia)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Abnormal glucose metabolism - hypoglycaemia or hyperglycaemia} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Thiamine deficiency} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Cardiac: arrhythmias, heart failure} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Respiratory: muscle weakness, respiratory failure} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Neurologic: confusion, seizures} \tn 
% Row Count 8 (+ 1)
% Row 6
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\mymulticolumn{1}{x{5.377cm}}{Haematologic: anaemia, impaired immune function} \tn 
% Row Count 9 (+ 1)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Intervention}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Initiate feeding once:}} 1. RFS Supps (PO4, K, Mg, B1) have commenced. 2. Electrolytes are monitored. 3. Abnormalities are corrected} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{High risk pts:}} Start rate = 50\% of goal {\emph{OR}} Commence low-CHO feed @ \textasciitilde{}6000kJ/day. Increase by 2000kJ/day until goal is met.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Lower risk pts:}} Start @ 1800kcal/day. Gradually increase when biochem is stable, eg +400cal/week} \tn 
% Row Count 8 (+ 2)
% Row 3
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\mymulticolumn{1}{x{5.377cm}}{Avoid excessive Na (water retention)} \tn 
% Row Count 9 (+ 1)
% Row 4
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\mymulticolumn{1}{x{5.377cm}}{NGT - BMI \textless{}14kg/m2} \tn 
% Row Count 10 (+ 1)
% Row 5
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Sup}} 500mg PO4 bd. 100mg thiamine od for first week.} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Handbook p169} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{ASPEN consensus recommendations for refeeding syndrome (2020)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ESPEN basics in clinical nutrition: Refeeding syndrome (2010)} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Monitor weight daily} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{Electrolytes 6-8 hours after first re-feeding} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Daily bloods for the first week} \tn 
% Row Count 3 (+ 1)
% Row 3
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\mymulticolumn{1}{x{5.377cm}}{Second week = bloods 3/week} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{BGL 2/day} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}