Refeeding Syndrome

Refeeding syndrome is a common but under recognized condition.

Many at-risk patients such as chronic alcoholism, liver disease, chronic pancreatitis, perioperative patients (bowel strictures, IBD, Koch’s), GI cancer (chemoradiotherapy), patients referred for feeding access, will come to GI service.

The key problems of refeeding are hypophosphatemia, thiamine defi ciency, salt and water retention (edema/left ventricular failure). Hypophosphatemia is a life-threatening problem.

Neuropsychiatric manifestations may occur due to thiamine defi ciency (Wernicke’s encephalopathy).

NG feeding – higher risk than those given IV fl uids or parenteral nutrition.

Baseline evaluation includes labs (blood counts, electrolytes, phosphates, calcium, magnesium), liver biochemistry, KFT, sepsis screen, ECG, Echo, NT-proBNP, chest X-ray and ultrasound.

Do not rush to give carbohydrates, exercise caution regarding fl uids. Document feeding protocol, adhere to it and audit periodically.