Refeeding Syndrome: Pathogenesis and clinical findings Patients at Risk of Refeeding Syndrome: - Little or no nutritional intake in recent past - Significant weight loss - Low BMI < 18.5 kg/m2 - Electrolyte disturbances: low K, PO4& Mg prior to feeding - History of alcohol abuse or drugs including diuretics, insulin, chemotherapy and or antacids RAPID REFEEDING -> -> Incr glucose, fluid, salt and nutrients from any source; oral, enteral or parenteral -> Insulin secretion • Incr Na retention -> Fluid overload -> - CHF - Pulmonary Edema - Cardiac Arrhythmias / Death • Incr Glucose Metabolism -> Decr Thiamine - Wernicke-Korsakoff Syndrome - Metabolic Acidosis • Shift of K, PO4 and Mg into cells -> Decr Serum K, Mg, Ca -> Changes in action potential threshold - Tetany - Cardiac Arrhythmias / Death • Incr synthesis of proteins -> decr Serum PO4 -> decr RBC ATP + 2,3-DPG -> - hemolysis - anemia - CNS: Tremors, Ataxia, Coma, Delirium - GI: Anorexia, Constipation - MSK: Weakness #Refeeding #Syndrome #diagnosis #pathophysiology #symptoms #signs
