We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Refeeding syndrome
From WikEM
Contents
Background
Mostly an issue with TPN, risk of death.
Pathophysiology
When a severely malnourished patient is given glucose, the following cascade of events takes place:
- Insulin is released
- this stimulates drive to produce ATP
- As ATP is produced, phosphorus is depleted
- As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell.
- this leads to hypokalemia, hypomagnesemia, and hypophosphatemia.
- Metabolic acidosis also develops.
- Electrolyte abnormalities can cause prolonged QTc
- Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status.
Clinical Features
Differential Diagnosis
- Fluid overload
- Insulin secretion
- Loss of myocardium
- Na absorption
- Mineral Depletion:
- Phosphorus
- K
- Na
- Mg
- Glucose Intoleraence
- Cardiac arrhythmas
- 1st wk
- Long QT
Evaluation
Workup
- CBC
- Chemistry
- Magnesium
- Phosphorus
- ECG
Findings
- hypokalemia, hypomagnesemia
- Metabolic acidosis
- ECG: May cause prolonged QTc
- hypophosphatemia
- Leading to hemolysis, hypotension, altered mental status
Management
See Also
References
- Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74
- Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165.
