Pathophysiology of Refeeding Syndrome Essay

Refeeding syndrome (RFS) is an acute alteration in fluid and electrolyte equilibrium that occurs in underfed patients following nutritional assistance (Yantis & Velander, 2009). Parenteral nutrition is the most common cause of RFS although enteral nutrition and oral administration of I.V fluids with dextrose can also cause it. The initial case of RFS was observed after the Second World War when feeding of malnourished casualties led to cardiac and neurologic malfunction (Rio et al., 2013). Presently, most cases of RFS arise in hospitalized patients with a large proportion of the patients showing electrolyte imbalance. RFS is characterized by reduced concentrations of magnesium, potassium or phosphorus (Mehanna, Moledina, & Travis, 2008). These symptoms manifest within the first 72 hours after initiation of feeding and can continue for the subsequent two to seven days (Yantis & Velander, 2009). in the initial 48 hours while neurologic disorders occur later. Any malnourished individual is at risk of RFS. However, persistent alcoholism, and the risk of RFS.

Pathophysiology of Refeeding Syndrome
The body has a preference for glucose (which comes from the ingestion of carbohydrates) as the key source of fuel. Prolonged starvation depletes glucose reserves causing the body to move to the breakdown of protein and fat for energy. Consequently, the quantity of insulin falls because of the reduced availability of carbohydrates. A steady reduction of cellular and muscle mass then arises causing the degeneration of essential organs such as the heart, intestines and liver. Therefore, cardiac and respiratory performances weaken leading to a slow metabolic rate. Nutritional support (refeeding) can be attempted to restore the bodys activities. However, if done aggressively such as in parenteral feeding, refeeding can cause adverse consequences mainly because of the alteration in the production of insulin. Restoring glucose in the body increases the amount of insulin, which promotes cellular uptake of such as phosphate, potassium and magnesium. This causes hypophosphatemia, hypokalemia and hypomagnesemia (Khan et al., 2011).

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Nursing and Medical Management of Refeeding Syndrome
Nurses must work together with dietitians, health care providers and pharmacists to prevent RFS (Yantis & Velander, 2009). Nurses ought to recognize patients at risk from their pre admission medical history and promptly detect the signs of RFS. This involves checking serum electrolyte concentrations and making certain that they are normal ahead of . If abnormal, the electrolyte levels ought to be corrected without delay. The administration of phosphate to anorexia nervosa patients prevents RFS (Rio et al., 2013). Blood pressure and pulse rate also need to be checked. It is important to restore blood volume, but care is required to prevent fluid overload. In addition, it is mandatory that the refeeding rate is closely supervised and should begin with a low caloric intake that is gradually increased as the body adjusts to food. Patients are advised to take small food portions that are low in glucose especially protein-rich foods. The initial three days of refeeding are crucial, and a nurse needs to monitor the electrolyte levels during this time. Vitamin concentrations (especially thiamine) also require checking to prevent confusion and ataxia. Hyperglycemia can be prevented by monitoring the blood glucose and ensuring that it does not exceed 200 mg/dL (Yantis & Velander, 2009). Since RFS patients can develop neurological and cognitive changes, fall risk measures need to be established to ensure the safety of the patients.


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