Diferencia entre revisiones de «Refeeding syndrome»
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*Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status. | *Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status. | ||
== | ==Evaluation== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revisión del 09:10 25 jul 2016
Background
Mostly an issue with TPN, risk of death.
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.
Evaluation
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
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.