refeeding syndrome

see also:

• alcohol dependence
• starvation
• anorexia nervosa / eating disorders
• geriatrics

• Refeeding syndrome consists of adverse metabolic effects that occur when a starved or malnourished individual re-commences feeding, particularly with carbohydrate.

• Hypophosphataemia
• Hypokalaemia
• Hypomagnesaemia
• Sodium and fluid retention
• Altered glucose metabolism
• Micronutrient deficiencies (particularly thiamine)
• in severe cases:
  • decreased respiratory function
  • neuromuscular dysfunction
  • haematological dysfunction
  • hepatic dysfunction
  • cardiac failure
  • multi system organ failure
  • death

• BMI < 14kg/m2, or,
• Very little or no nutritional intake for > 10-15 days

• BMI less than 16kg/m2, or,
• Little or no nutritional intake for >10 days with evidence of physiological stress and depletion, or,
• Unintentional weight loss > 15% over recent 3-6 months including obese patients

• two or more of:
  • BMI <18.5kg/m2 (consider ethnic background).
  • Unintentional weight loss > 10% over recent 3-6 months including obese patients.
  • Little to no nutritional intake for >5days.
  • Serum potassium, phosphate and/or magnesium levels below normal reference range prior to feeding.

• frail elderly
• anorexia nervosa
• chronic alcoholism
• oncology patients
• chronic malabsorption (eg. Crohns, pancreatic insufficiency)
• severe malnourishment
• morbidly obese with rapid wait loss (eg. bariatric surgery)
• uncontrolled diabetes with electrolyte disturbance and diueresis

• all patients at risk who are not for palliative care:
  • IV thiamine prior to commencing carbohydrates (failure to do so risks Wernicke's encephalopathy)
  • multi-vitamins
  • early dietitian involvement
  • initiate feeding SLOWLY (eg. small frequent meals) and gradual increase over 4-7 days
  • monitor biochemistry and Rx as needed