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Refeeding Syndrome
Potentially fatal shifts in fluid and electrolytes (especially hypophosphatemia) that occur when reintroducing nutrition to a severely malnourished patient.
Also: RFS
After prolonged starvation, the body adapts to using fat and protein for energy. Reintroducing carbohydrate triggers a surge of insulin that drives phosphorus, potassium, and magnesium intracellularly, and increases thiamin demand. The result can be cardiac arrhythmias, respiratory failure, and death. Prevention requires identifying at-risk patients, starting at 25 to 50% of estimated energy needs, slow advancement, thiamine supplementation, and aggressive electrolyte monitoring and repletion.
How each textbook covers it
Krause and Mahan's Food and the Nutrition Care Process, 16th ed. — Chapter 12
After prolonged starvation, the body adapts to using fat and protein for energy. Reintroducing carbohydrate triggers a surge of insulin that drives phosphorus, potassium, and magnesium intracellularly, and increases thiamin demand. The result can be cardiac arrhythmias, respiratory failure, and death. Prevention requires identifying at-risk patients, starting at 25 to 50% of estimated energy needs, slow advancement, thiamine supplementation, and aggressive electrolyte monitoring and repletion.
Modern Nutrition in Health and Disease, 12th ed. — Ch 91: Nutrition Support
Insulin surge with refeeding drives intracellular uptake of phosphate, potassium, and magnesium, depleting their serum levels in patients with low body stores. Manifestations include cardiac arrhythmias, respiratory failure, Wernicke encephalopathy, and rhabdomyolysis. Prevention: identify high-risk patients (BMI <16, weight loss >15%, minimal intake >10 days), supplement thiamine before nutrition, start at 5-10 kcal/kg/d advancing slowly, monitor and correct electrolytes daily.
Related terms
Enteral Nutrition, Malnutrition, Parenteral Nutrition, Phosphate, Thiamine, Wernicke encephalopathy