Refeeding syndrome: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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Mostly an issue with TPN, risk of death. | Mostly an issue with TPN, risk of death. | ||
===Pathophysiology=== | |||
When a severely malnourished patient is given glucose, the following cascade of events takes place: | When a severely malnourished patient is given glucose, the following cascade of events takes place: | ||
*Insulin is released | *Insulin is released | ||
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*Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status. | *Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status. | ||
== | ==Clinical Features== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**1st wk | **1st wk | ||
**[[Long QT]] | **[[Long QT]] | ||
==Evaluation== | |||
===Workup=== | |||
*CBC | |||
*Chemistry | |||
*Magnesium | |||
*Phosphorus | |||
*ECG | |||
===Findings=== | |||
*[[hypokalemia]], [[hypomagnesemia]] | |||
*[[Metabolic acidosis]] | |||
*ECG: May cause [[prolonged QTc]] | |||
*[[hypophosphatemia]] | |||
**Leading to hemolysis, [[hypotension]], [[altered mental status]] | |||
==Management== | ==Management== | ||
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<references/> | <references/> | ||
#Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74 | #Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74 | ||
#Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165. | #Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165. | ||
[[Category:FEN]] | [[Category:FEN]] | ||
Revision as of 22:13, 22 September 2016
Background
Mostly an issue with TPN, risk of death.
Pathophysiology
When a severely malnourished patient is given glucose, the following cascade of events takes place:
- Insulin is released
- this stimulates drive to produce ATP
- As ATP is produced, phosphorus is depleted
- As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell.
- this leads to hypokalemia, hypomagnesemia, and hypophosphatemia.
- Metabolic acidosis also develops.
- Electrolyte abnormalities can cause prolonged QTc
- Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status.
Clinical Features
Differential Diagnosis
- Fluid overload
- Insulin secretion
- Loss of myocardium
- Na absorption
- Mineral Depletion:
- Phosphorus
- K
- Na
- Mg
- Glucose Intoleraence
- Cardiac arrhythmas
- 1st wk
- Long QT
Evaluation
Workup
- CBC
- Chemistry
- Magnesium
- Phosphorus
- ECG
Findings
- hypokalemia, hypomagnesemia
- Metabolic acidosis
- ECG: May cause prolonged QTc
- hypophosphatemia
- Leading to hemolysis, hypotension, altered mental status
Management
See Also
References
- Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74
- Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165.