Question

What is the suggested dietary regime for avoiding refeeding syndrome in patients that have been with little or no food for over 5 days? What is the metabolic reason for your prescribed treatment?

Answer 1

Dietary Regime for Refeeding Syndrome:

Refeeding is the process of feeding again , especially after a period of starvation or malnourishment. Refeeding Syndrome refers to a group of symptoms that occur as a result of dangerous shift in electrolytes and fluids in the body system, that may lead to respiratory problems, cardiovascular complications , seizures or death.

Dietary Regime:

Physician and healthcare professionals has to be more careful during the treatment of Patient with refeeding syndrome. After assessing the severity of Refeeding Syndrome by checking the mental status, neurological signs, muscle weekness etc, Doctors has to replace the normal electrolyte levels in patient with Intravenous infusion of electrolytes and fluids along with Thiamine and other vitamins.  

* Thiamine ( 200 to 300 mg / day ), before feeding starts. Vitamin B tablets, Multivitamin supplements.

* Feeding initiate with 0.0418 MJ/ kg/ day .

(MJ/ kg /day - Megajoule/ kilogram).

* After 4 days of initial feeding , increase the amount of feeding.

* Supplement potassium, calcium, phosphate , magnesium intravenously along with fluids. Rehydrate the patient carefully.

* Avoid heavy foods like deep fried items, fatty items, meats, whole grains etc on the initial days.

Metabolic reason for the prescribed treatment:

When a patient is on continous starvation body's digestive capacity is getting compromised and insulin production may become significantly reduced . Body switch on to starvation mode and the it start to utilize reserved fat for the energy production. Continous dependency on reserved fat for energy changes the metabolism process and causes changes in electrolyte levels. Potassium, magnesium, calcium, phosphorous and thiamine levels are getting affected more.

During the initiation time of Refeeding process, there will be sudden shift in the metabolic process and electrolytes levels, as a result of ingestion of food and consequent digestion. Sudden intake of glucose, more insulin secretion and resultant lack of electrolytes such as phosphorus may produce certain complications. These changes may affect heart, lungs , kidney , blood , muscles etc. Hypophosphatemia may lead to Acute heart failure, confusion, seizures etc.  So there should be careful and gradual introduction of Refeeding process.