Refeeding syndrome

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.

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

See Also

• Nutrition (main)