Refeeding syndrome

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

Evaluation

Workup

  • CBC
  • Chemistry
  • Magnesium
  • Phosphorus
  • ECG

Findings

Management

See Also

References

  1. 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
  2. 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.

Authors:

Ross Donaldson