Refeeding syndrome: Difference between revisions
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**As ATP is produced, phosphorus is depleted | **As ATP is produced, phosphorus is depleted | ||
**As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell. | **As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell. | ||
**this leads to hypokalemia, hypomagnesemia, and hypophosphatemia. | **this leads to [[hypokalemia]], [[hypomagnesemia]], and [[hypophosphatemia]]. | ||
**Metabolic acidosis also develops. | **[[Metabolic acidosis]] also develops. | ||
*Electrolyte abnormalities can cause prolonged QTc | *Electrolyte abnormalities can cause [[prolonged QTc]] | ||
*Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status. | *Rapid phosphorus depletion can lead to [[hemolytic anemia|hemolysis]], [[hypotension]], [[altered mental status]]. | ||
==Clinical Features== | ==Clinical Features== | ||
*Fluid overload, [[CHF]] | *[[Fluid overload]], [[CHF]] | ||
*[[Altered mental status]] | *[[Altered mental status]] | ||
*[[Seizure]] | *[[Seizure]] | ||
*[[Rhabdomyolysis]] | *[[Rhabdomyolysis]] | ||
*Hemolysis | *[[hemolytic anemia|Hemolysis]] | ||
*Symptomatic from hypophosphatemia, hypokalemia, hypomagnesemia | *Symptomatic from [[hypophosphatemia]], [[hypokalemia]], [[hypomagnesemia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 27: | Line 27: | ||
**Na absorption | **Na absorption | ||
*Mineral Depletion: | *Mineral Depletion: | ||
**Phosphorus | **[[hypophosphatemia|Phosphorus]] | ||
**K | **[[hypokalemia|K]] | ||
**Na | **[[hyponatremia|Na]] | ||
**Mg | **[[hypomagnesemia|Mg]] | ||
*Glucose | *Glucose Intolerance | ||
*[[Cardiac | *[[Cardiac arrhythmias]] | ||
**1st wk | **1st wk | ||
**[[Long QT]] | **[[Long QT]] | ||
| Line 49: | Line 49: | ||
*[[ECG]]: May cause [[prolonged QTc]] | *[[ECG]]: May cause [[prolonged QTc]] | ||
*[[Hypophosphatemia]] | *[[Hypophosphatemia]] | ||
**Leading to hemolysis, [[hypotension]], [[altered mental status]] | **Leading to [[hemolytic anemia|hemolysis]], [[hypotension]], [[altered mental status]] | ||
==Management== | ==Management== | ||
Revision as of 16:32, 29 September 2019
Background
Mostly an issue with TPN, risk of death.
Pathophysiology
When a severely malnourished patient is given glucose, the following cascade of events takes place:
- Insulin is released
- this stimulates drive to produce ATP
- As ATP is produced, phosphorus is depleted
- As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell.
- this leads to hypokalemia, hypomagnesemia, and hypophosphatemia.
- Metabolic acidosis also develops.
- Electrolyte abnormalities can cause prolonged QTc
- Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status.
Clinical Features
- Fluid overload, CHF
- Altered mental status
- Seizure
- Rhabdomyolysis
- Hemolysis
- Symptomatic from hypophosphatemia, hypokalemia, hypomagnesemia
Differential Diagnosis
- Fluid overload
- Insulin secretion
- Loss of myocardium
- Na absorption
- Mineral Depletion:
- Glucose Intolerance
- Cardiac arrhythmias
- 1st wk
- Long QT
Evaluation
Workup
- CBC
- Chemistry
- Magnesium
- Phosphorus
- ECG
Findings
- Hypokalemia, hypomagnesemia
- Metabolic acidosis
- ECG: May cause prolonged QTc
- Hypophosphatemia
- Leading to hemolysis, hypotension, altered mental status
Management
See Also
References
- Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74
- Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165.