title: Refeeding tags: #FFICM #Medicine #Nutrition notebook: ð-FFICM
source: [[eLfH]] category: [[nutrition]]
Nutrition in critical care
Refeeding
This is a condition occuring after restarting nutrition after starvation. 1
Cells increase their uptake of phosphate resulting in:
- Severe serum hypophosphataemia
- Hypokalaemia
- Hypomagnasaemia 1
In a metanalysis, 34% of patients on ICU experienced hypophosphataemia after feeding was restarted. 2
Risk Factors:
- Post Op
- Chronic Malnutrition/Malabsorption (IBD/Pancreatitis/Short Bowel/CF/Marasmus)
- Morbid Obese with Profound Weight Loss
- "High Stress" patients unfed for 7+ days
- Prolonged Fasting
- Chronic Alcoholism
- Oncology 2
NICE Criteria for at-risk groups is2:
| One Or More Of | Two Or More Of |
|---|---|
| BMI <16 | BMI <18.5 |
| Weight Loss > 15% in last 6 Months | Weight Loss > 10% last 6 months |
| Little nutritional intake past 10 days | Little nutritional intake past 5 days |
| Low K, Phos, Mg before feeding | History of alcohol/drugs/medications putting at risk* |
- Insulin, Chemo, Antacids, Diuretics
| Flashcard | type:basic |
|---|---|
| How low does your BMI need to be at very high risk of refeeding? | Less than 16 |
| How low does your BMI need to be at high risk of refeeding? | Less than 18 |
| How long do you need to have been starved from to be at very high risk of refeeding? | 10 days plus |
| How long do you need to have been starved from to be at high risk of refeeding? | 5 days plus |
| How high should amount of feed be, to reduce the risk of refeeding in those who had been starved? | ~50% of energy requirements |
| How long should you be on a reduced amount of feed after starving, if attempting to avoid risk of refeeding? | 5 days |
Cloze
| Flashcard | type:cloze |
|---|---|
| NICE Classify those at very high risk of refeeding as people with: {{c1::BMI less than 16}} {{c2::Starvation for more than 10 days}} {{c3::Weight Loss of 15%+}} {{c4::Electrolyte Derangement}} |
|
| The classic derangement of electrolytes in refeeding syndrome would be low {{c1::phosphate}}, {{c1::potassium}}, and {{c1::magnesium}} | |
| In patients who have been starved, you should give {{c1::thiamine}} before feeding to reduce the risk of {{c2::Wernicke's encephalopathy}} |
Clinically that will show as:
- Confusion
- Delirium
- Seizures
- Respiratory Failure
- Rhabdomyolysis
- CV Collapse 1
It can precipitate Wernicke's encephalopathy, so thiamine should be given before feeding restarts. 2
You can prevent it using a restricted calorie intake over the first few days. 1
The trial of this reduced 60 day mortality and reduced resp infections. 1
Plus some more questions from [[mcqs-and-sbas-in-intensive-care-medicine-oxford-higher-special-training]]
| Flashcard | type:basic |
|---|---|
| Does malabsorption increase your risk of refeeding syndrome? | Yes |
| Does alcoholism increase your risk of refeeding syndrome? | Yes |
| Does diabetes increase your risk of refeeding syndrome? | Yes |
| Does being elderly increase your risk of refeeding syndrome? | Yes |
| Does PPI use increase your risk of refeeding syndrome? | No |
| Does renal failure increase your risk of refeeding syndrome? | No |
| Does anorexia increase your risk of refeeding syndrome? | Yes |
| Does malignancy increase your risk of refeeding syndrome? | Yes |
| Does malignancy increase your risk of refeeding syndrome? | Yes |
| Does diuretic use increase your risk of refeeding syndrome? | Yes - Electrolyte Mess up |
| Does antacid use increase your risk of refeeding syndrome? | Yes - Chelated Phospate |