From the Guidelines
The electrolyte abnormalities associated with refeeding syndrome are hypophosphatemia, hypokalaemia, and hypomagnesemia.
Key Electrolyte Abnormalities
- Hypophosphatemia: the most frequent electrolyte disturbance, driving many of the medical complications of refeeding syndrome 1
- Hypokalaemia: often occurs alongside hypophosphatemia, requiring monitoring and substitution with approximately 2-4 mmol/kg/day 1
- Hypomagnesemia: also common, with requirements of approximately 0.2 mmol/kg/day if supplied intravenously or 0.4 mmol/kg/day if supplied orally 1
Monitoring and Substitution
It is essential to monitor and substitute these electrolytes, as well as supply vitamin B1 in daily doses of 200-300 mg, to prevent the complications of refeeding syndrome 1.
Risk Factors and Prevention
Patients at high risk of refeeding syndrome include those with chronic alcoholism, severe chronic undernutrition, anorexia nervosa, or depleted patients with acute illness, and should be screened for risk factors such as low BMI, unintentional weight loss, and little or no intake for an extended period 1.
Clinical Recommendations
Initial energy supply should not exceed 5-10 kcal/kg/day, with a slow increase over 4-7 days, and close monitoring of volume of circulation, fluid balance, heart rate, and rhythm, as well as clinical status 1.
From the Research
Electrolyte Abnormalities in Refeeding Syndrome
The electrolyte abnormalities associated with refeeding syndrome include:
Clinical Features and Complications
Refeeding syndrome can lead to significant morbidity and mortality, with clinical features including:
- Fluid-balance abnormalities 2, 3, 6
- Abnormal glucose metabolism 2, 3, 6
- Neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications 3, 6
- Thiamine deficiency 2, 5
Pathogenesis and Diagnosis
The pathogenesis of refeeding syndrome involves a shift from catabolic to anabolic metabolism, leading to a sudden demand for electrolytes and resulting in decreased serum levels 4, 5. The diagnosis of refeeding syndrome can be challenging due to the lack of a universal definition and the presence of similar electrolyte imbalances in other conditions, such as acute thiamine deficiency 4, 5.