# Refeeding Syndrome
-- History: *** eating disorder, N/V/D, malignancy, GI disease; RFs: little/no nutrition for 5-10 days, older age, low BMI, low baseline electrolytes, unintended weight loss in short period of time, alcohol misuse
-- Clinical/Exam: *** tachycardia, tachypnea, edema; Phos – weakness, paresthesia, seizure, AMS, cramps; K and Mg – QTc, arrhythmia, weakness; Na retention (overload); Thiamine – Wernicke-Korsakoff, neuropathy
-- Data: *** K, Mg, Phos
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Monitor: BMP, Mg, Phos at least BID for 72 hours
-- Aggressive Repletion of K, Mg, Phos via IV
-- Thiamine and Multivitamin for all patients
-- Nutrition: reduced calories → full calorie goal over 5-10 days; reduce calories if the patient develops worsening edema
-- Na and fluid restriction for 7 days if c/f overload
PDF coming soon!
Refeeding syndrome is a life-threatening condition and is easily screened for, so its best to be over-cautious. The syndrome is the constellation of symptoms that occur with the depletion of electrolytes and vitamins associated with switching from a catabolic to an anabolic state. The biggest risks are arrythmias secondary to profound hypokalemia or hypomagnesemia. Trend BMP, Mg, and Phos BID for at least 72 hours, and slowly introduce calories or pull back if there is evidence of the syndrome developing.