Refeeding Syndrome Overview What Is It? • Electrolyte/fluid shifts caused by initiation of nutrition in severely malnourished patient. This can be fatal. • These shifts result from hormonal and metabolic changes and may cause severe clinical complications. Risk Factors: • Poor/minimal intake for >7 days • Significant weight loss • History of excessive alcohol intake • Malnutrition due to chronic disease/malabsorptive conditions • Anorexia nervosa • Persistent N/V/D • Poorly controlled diabetes • Oncological conditions • Post-operative state Characterized By: Early: • Hypo-Phos • Hypo-K • Hypo-Mg2+ • Vitamin deficiency (thiamine) Late: • Cardiac decompensation (CHF) • Respiratory failure (volume overload) Other Symptoms: • N/V • Palpitations • Diarrhea • Tremors • Paresthesias • Rhabdomyolysis • Seizures • Hemolysis • Delirium DDX: • Congestive heart failure • Epilepsy • Fanconi syndrome • Tumor-induced osteomalacia • Intestinal malabsorption • Nephrotic syndrome • Wernicke encephalopathy • Pellagra • Vitamin D deficiency • Primary hyperparathyroidism • Secondary hyperparathyroidism Treatment/Prevention: • Monitoring and correction of electrolyte abnormalities before refeeding (Phos, K, Mg2+) • Slow initial feeding • Monitor on telemetry for arrhythmias • Thiamine before initiation of feeding • Arrhythmias are the leading cause of death • Stop feeding if electrolyte abnormalities persist #Refeeding #Syndrome #Nutrition #Differential #Diagnosis #Pathophysiology