For Your Information... Refeeding Syndrome

A question on Refeeding Syndrome was asked on the February 2013 London Exam.

Refeeding syndrome

Definition
Metabolic disturbances that result from reinstitution of nutrition to patients who are starved or severely malnourished.

Pathogenesis
During prolonged fasting the body conserves muscle and protein breakdown by metabolising fatty acids to ketone bodies as its main energy source. The liver reduces gluconeogenesis, thus conserving muscle and protein.

Insulin secretion Decreased, Glucagon secretion Increased

Intracellular minerals are severely depleted in order to keep serum levels normal.

Once patients start feeding again the following occurs:

1. Increased blood sugar stimulates insulin secretion
2. Glycogen, Fat and Protein synthesis increases
3. Basal metabolic rate rises
4. Serum electrolytes move into intracellular space
5. Serum levels of phosphate, magnesium and potassium are quickly used up in the formation ATP and phosphorylation of carbohydrates
6. The precipitous drop in serum mineral levels causes cardiac arrhythmias, confusion, coma, cardiac failure and death.

Treatment

• High index of suspicion
• Close monitoring of blood biochemistry with adequate replacement either enterically or parenterally if required
• Thiamine and Vit B Complex supplementation is recommended
• Limit energy intake for first 3-5 days of commencement of feeding to 50-70% of normal daily requirements