Fluids, Electrolytes & Nutrition: Refeeding Syndrome

Definition

• Clinical Complications that Occur from Aggressive Nutritional Support of Malnourished Patients
• Generally Occurs After Prolonged Starvation (Around Day 2-4)

Pathophysiology

• Nutritional Supports Causes a Shift from Fat to Carbohydrate Metabolism
• Sudden Increase in Glucose Causes Increased Insulin Release
• Insulin Release Causes Cellular Uptake of Electrolytes (Phosphorous, Potassium & Magnesium)
• Insulin Release Also Causes Increased Intracellular ATP Production Further Depleting Phosphorous Stores

Presentation

• Electrolyte Abnormalities:
  • Low Phosphorous – Hallmark Electrolyte Disturbance
  • Low Potassium
  • Low Magnesium
• Complications:
  • Cardiac Dysfunction – Most Common Cause of Death
  • Failure to Wean from Ventilator
  • Weakness
  • Encephalopathy

Treatment

• Supportive Management
• Slow Rate of Nutrition
• Aggressively Correct Electrolyte Abnormalities