Presented by Kayla Koch, MD (PGY-1)
- Who is at risk for refeeding syndrome?
- What is the best initial management in a patient at risk for refeeding syndrome?
- “Fed” state:
- Carbs provide most energy needs. Glucose→ insulin→ increased glycogenesis, decreased lipolysis. If glycogen stores maxed, also increases lipogenesis.
- “Starved” state: Catabolism
- Glucose falls→ inc glucagon, dec insulin→ glycogenolysis→ energy from protein, fat→ lose body stores (catabolism)→ depletion of K, Ph, Mg→ intracellular stores released
- “Refeeding” State: Catabolism to anabolism
- Glucose→ insulin→ ions into cells→ hypo-P, K, Mg→ Na/water retention
- Reactivation of carb-dependent pathways→ increased thiamine demand
- RFS – Key Features:
- Na and fluid retention
- Thiamine (B1) deficiency
- RFS Management:
- 3 Key Points:
- Early recognition of those at risk
- Appropriate refeeding regimen
- Monitoring frequently
- 3 Key Points:
- RFS is metabolic & biochemical changes that occur from reintroduction of feeds after starvation/fasting
- At risk: Anorexia nervosa, chronic malnutrition, Marasmus, Kwashiorkor, at least 10-14 d fasting/underfeeding, prolonged IV hydration, massive weight loss
- No consensus on best management strategy, but start slow and monitor frequently
- More research needed!
Fuentebella J, Kerner JA. Refeeding syndrome. Pediatr Clin North Am. 2009 Oct; 56(5):1201-10.
Khan LU, Ahmed J, Khan S, Macfie J. Refeeding syndrome: a literature review.
Gastroenterol Res Pract. 2011;2011. pii: 410971.
O’Connor G, Nicholls D. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutr Clin Pract. 2013 Jun;28(3):358-64.