MANAGING REFEEDING SYNDROME IN TPN

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Dan Nugget
* Refeeding syndrome is a metabolic complication that occurs when nutritional support is given to severely malnourished patient 
* It results from overly aggressively feeding patients who are severely malnourished or who haven’t eaten in a long period of time

* Results in a shift of potassium and phosphorus into the body’s cells for ATP production, resulting in electrolyte imbalance

* Insulin is released on carbohydrate intake, triggering cellular uptake of potassium, phosphate, and magnesium

* Refeeding a severely malnourished patient should occur gradually, and the patient should be monitored closely
* Nutritional support should initially be delivered at a maximum of 10 kcal/kg/day
* Raise gradually to full requirement within a week
* In extreme cases energy intake should be limited to 5 kcal/kg/day
* Characteristics of the Refeeding syndrome include:
*Hypophosphatemia* 

*Hypokalemia*

*Hypomagnesemia*

*Hyperglycemia*

*Fluid retention*

*Cardiac arrest*

 *Recommend the following*

 * 200-300 mg oral thiamine a day, 1-2 strong tablets vitamin B co strong tablets (x3) or intravenous vitamin B, and a balanced multivitamin and mineral supplement/day  should be recommended each day, before and during the first 10 days of feeding

* Monitor and recommend the following:
Oral, enteral, or intravenous potassium, phosphate and magnesium intake 

# An average of 2-4 mmol/kg/day potassium, 0.3-0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium should be recommended

*In patients with serious comorbidity*
* Design the prescription to provide 50% of the nutritional needs initially 

* Build up to a full prescription within 24-48 hours.
*STAY HEALTHY AND OBEY GOD*
*Maduforo Aloysius RDN*

Have a great day ahead

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