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Refers to the severe fluid and electrolyte abnormalities and hyperglycaemia that may occur when a malnourished or starved pt is recommenced on oral, enteral or parenteral nutrition
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Can result from metabolic or hormonal abnormalities
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If unrecognised and left untreated, complications arise and can be fatal
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Syndrome relates to suppressed release of insulin duration starvation so that when feeding restarts, hypophosphataemia can occur
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Important to screen for pts at risk of re-feeding syndrome, e.g. pts who have been starved for more than 1 week
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Abnormalities may persist for 3-4 days after feeding restarts
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Characterized by low levels
- Phosphate
- Potassium
- Magnesium
- Sodium
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Sequele
- Cardiac arrhythmias
- Heart failure
- Muscle weakness
- Rhabdomyolysis
- Seizures
- Altered sensation
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Pathophysiology
- Reintroduction of carbohydrates
- Leads to the release of insulin
- This increases the cellular uptake of all of the ions
- Reducing the levels in the systemic circulation
- Phosphate is especially affected because the cells have been using the intracellular phosphate stores to synthesize ATP, using protein and fat as a fuel.
- There is massive depletion of intracellular phosphate, although the extracellular phosphate has been maintained at deceptively normal levels throughout the state of starvation