Friday, June 21, 2019

Understanding Refeeding Syndrome

Refeeding syndrome is a life-threatening metabolic complication of - stay with me - refeeding. It can happen via any route after prolonged starvation.

Who are at risk?
They’re patients with prolonged artifical feeding [parenteral or enteral], malignancy, anorexia and alcoholism.

Why does it happen?
During starvation, the body uses fat and protein for energy. There’s no carbs so there’s little to no insulin.

After refeeding, carbohydrate load causes a spike in insulin level.
Now first prof biochemistry tells you, more insulin means more cellular uptake of phosphate.
That’s it. That low serum phosphate level is the main problem.

How does it present?
Non-specifically and catastrophically. Features are rhabdomyolysis, red and white blood cell dysfunction, respiratory insufficiency, cardiac arrhythmias and seizures.
Left unchecked, it can lead to sudden death.

How do I prevent it?
Identify at-risk patients and give high-dose, high-potency Vitamin C and B complex injection, during re-feeding window.
Monitor vitals and labs closely. Close involvement of nutritionist is ideal.

What if it’s already happened? How do I treat it?
The biggest challenge is management of complications.
As regards phosphate, get the levels back up. Administer oral as well as parenteral phosphate, upto 18 mmol per day.

Thank you, that’d be all.
- Ashish Singh.

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